Additionally, these platforms, with the entry of new companies into the market in the upcoming years, the growth of the global endourological robot market, potential cost savings through cheaper devices, and increased competition among industries are on the agenda.1
In this context, we shared our experience with the Roboflex Avicenna™ Platform. Firstly, this robotic system consists of two main parts: the master and slave console. Moreover, having X-ray and laser pedals on the master console provides a significant advantage. We anticipate that endourologists' increasing radiation exposure can be partially mitigated by positioning them away from the X-ray device through the master’s console and using lead blocks between the master console and the patient. The control of laser settings and movements from the master’s console not only eases the surgeon's effort but also reduces the need for assistance from assistants and nurses, which is crucial for the focus and comfort of the endourologist.
Furthermore, the control of irrigation speed from the master’s console allows the endourologist to reduce dependency on others and maintain the balance between intrarenal pressure increase and visual quality with objective and minimal changes. Moreover, respiratory adjustments can also be made from the master’s console, enhancing the endourologists' attention to the stone with minimal kidney movements.
The joystick control resembling standard f-URS devices is believed to shorten the learning curve to robo-URS. It is evident that it significantly improves ergonomics.2 In a survey conducted among endourologists in 2011, 64% reported orthopedic problems.3 Especially among high-volume surgery endourologists, we anticipate an increase in musculoskeletal diseases with age. Improving ergonomics and reducing radiation exposure with robo-URS are crucial for endourologists. We should consider ourselves as much as we consider our patients!
As a disadvantage, starting the surgery in a sterile manner, then continuing non-sterile, and becoming sterile again at the end may disrupt orientation for the endourologist. However, this does not stand as a major drawback. Robotic docking time is an additional step not present in conventional URS, taking extra time. However, in the first 10 cases, this time averaged 21 minutes, while in the last 8 cases, it decreased to an average of 6 minutes. Cost analyses are also among the disadvantages.
In this video article, we demonstrated the technical details of robo-URS for kidney stones, providing a valuable resource for all urologists, with a particular focus on novices. Additionally, we presented the first video article on Robo-URS in a scientific journal.
Written by: Rifat Burak Ergül, MD, & Tzevat Tefik, MD
Istanbul University, Istanbul Faculty of Medicine, Urology Department, Istanbul, Turkey
References:
- Sinha MM, Gauhar V, Tzelves L, et al. Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime? Curr Urol Rep. 2023;24:391-400.
- Park J, Gwak CH, Kim D, et al. The usefulness and ergonomics of a new robotic system for flexible ureteroscopy and laser lithotripsy for treating renal stones. Investig Clin Urol. 2022;63:647-55.
- Elkoushy MA, Andonian S. Prevalence of orthopedic complaints among endourologists and their compliance with radiation safety measures. J Endourol. 2011;25:1609-13.