Schlager Daniel, Hein Simon, Obaid Moaaz Abdulghani, Wilhelm Konrad, Miernik Arkadiusz, Schoenthaler Martin
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg , Germany, Freiburg, Germany .
J Endourol. 2017 Nov;31(11):1139-1144. doi: 10.1089/end.2017.0454. Epub 2017 Nov 7.
To evaluate and compare FlexorVue™, a semidisposable endoscopic deflection system with disposable ureteral sheath and reusable visualization source, and a nondisposable fiber optic ureteroscope in a standard in vitro setting.
FlexorVue and a reusable fiber optic flexible ureteroscope were each tested in an artificial kidney model. The experimental setup included the visualization of colored pearls and the extraction of calculi with two different extraction devices (NCircle and NGage). The procedures were performed by six experienced surgeons. Visualization time, access to calices, successful stone retraction, and time required were recorded. In addition, the surgeons' workload and subjective performance were determined according to the National Aeronautics and Space Administration-task load index (NASA-TLX). We referred to the Likert scale to assess maneuverability, handling, and image quality.
Nearly all calices (99%) were correctly identified using the reusable scope, indicating full kidney access, whereas 74% of the calices were visualized using FlexorVue, of which 81% were correctly identified. Access to the lower poles of the kidney model was significantly less likely with the disposable device, and time to completion was significantly longer (755 s vs 153 s, p < 0.001). The stone clearance success rate with the disposable device was 23% using the NGage and 13% using the NCircle basket. Overall NASA-TLX scores were significantly higher using FlexorVue. The conventional reusable device also demonstrated superior maneuverability, handling, and image quality.
FlexorVue offers a semidisposable deflecting endoscopic system allowing basic ureteroscopic and cystoscopic procedures. For its use as an addition or replacement for current reusable scopes, it requires substantial technical improvements.
在标准体外环境中评估和比较FlexorVue™（一种带有一次性输尿管鞘和可重复使用可视化源的半一次性内镜偏转系统）和一种非一次性光纤输尿管镜。
FlexorVue和一种可重复使用的光纤软性输尿管镜分别在人工肾脏模型中进行测试。实验设置包括彩色珍珠的可视化以及使用两种不同的取出装置（NCircle和NGage）取出结石。手术由六位经验丰富的外科医生进行。记录可视化时间、进入肾盏的情况、结石成功取出情况以及所需时间。此外，根据美国国家航空航天局任务负荷指数（NASA - TLX）确定外科医生的工作量和主观表现。我们采用李克特量表评估可操作性、操控性和图像质量。
使用可重复使用的输尿管镜几乎所有肾盏（99%）都能被正确识别，表明可完全进入肾脏，而使用FlexorVue能可视化74%的肾盏，其中81%被正确识别。使用一次性装置进入肾脏模型下极的可能性显著降低，完成时间显著更长（755秒对153秒，p < 0.001）。使用一次性装置，使用NGage时结石清除成功率为23%，使用NCircle篮时为13%。总体而言，使用FlexorVue时NASA - TLX评分显著更高。传统的可重复使用装置在可操作性、操控性和图像质量方面也表现更优。
FlexorVue提供了一种半一次性偏转内镜系统，可进行基本的输尿管镜和膀胱镜检查程序。要将其用作当前可重复使用输尿管镜的补充或替代品，还需要进行大量技术改进。
