Department of Urology, Medical School Ulm, University of Ulm, 89075, Ulm, Germany.
Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, 74078, Heilbronn, Germany.
J Robot Surg. 2021 Apr;15(2):265-274. doi: 10.1007/s11701-020-01103-5. Epub 2020 Jun 16.
Flexible ureteroscopy is the keystone of modern kidney stone treatment. Although a simple surgical technique achieves good clinical results and a low complication rate, there are high demands on the surgeon's dexterity and ergonomic restrictions. Robotic-assisted flexible ureteroscopy (rfURS) could overcome these limitations. After 4 years of use of rfURS at a tertiary stone center, performance factors were analyzed to define the role of rfURS in kidney stone management. A rfURS system was installed in August 2014 at the SLK Kliniken (Heilbronn, Germany). Treatment data of N = 240 consecutive patients undergoing rfURS were prospectively collected and analyzed. The patient cohort represents typical stone formers. N = 240 renal units containing 443 stones with an average stone load of 1798 mm were treated. Surgical parameters as well as the peri- and postoperative complications were recorded, analyzed and compared to the current data in the literature. OR time 91 min, stone treatment time 55 min, stone treatment efficacy 33 mm/min; perioperative complications 5.4%; robot times: preparation 5 min, docking 5 min, console time to stone contact 6 min, console time 75 min; postoperative complications 6.7%; postoperative length of stay 1.5 days; stone-free rate (residuals < 2 mm) 90% and re-treatment rate 8.75%. This consecutive series represents real-life data about the utilization of rfURS. The detailed analysis of performance factors revealed the successful utilization of the first generation of robotic systems in endourologic stone surgery, and indicates that the robot performs comparably to conventional flexible URS. Optimal ergonomics maintain the surgeon's endurance in long-lasting surgeries.
软性输尿管镜检查是现代肾结石治疗的基石。虽然这是一种简单的手术技术，能够取得良好的临床效果和低并发症发生率，但对医生的灵巧性和符合人体工程学的要求很高。机器人辅助软性输尿管镜检查（rfURS）可以克服这些限制。在一家三级结石中心使用 rfURS 4 年后，分析了性能因素，以确定 rfURS 在肾结石管理中的作用。2014 年 8 月，在 SLK Kliniken（德国海尔布隆）安装了 rfURS 系统。前瞻性收集并分析了 240 例连续接受 rfURS 治疗的患者的治疗数据。该患者队列代表了典型的结石形成者。N = 240 个肾单位中含有 443 颗结石，平均结石负荷为 1798mm，接受了治疗。记录了手术参数以及围手术期并发症，并与当前文献中的数据进行了分析和比较。OR 时间为 91 分钟，结石处理时间为 55 分钟，结石处理效率为 33mm/min；围手术期并发症 5.4%；机器人时间：准备 5 分钟，对接 5 分钟，控制台与结石接触时间 6 分钟，控制台时间 75 分钟；术后并发症 6.7%；术后住院时间 1.5 天；结石清除率（残余物 < 2mm）为 90%，再治疗率为 8.75%。这一系列连续病例代表了 rfURS 使用的真实数据。性能因素的详细分析显示了第一代机器人系统在腔内泌尿外科结石手术中的成功应用，并表明机器人的性能与传统软性 URS 相当。最佳的人体工程学可维持医生在长时间手术中的耐力。
