Kwok Jia-Lun, De Coninck Vincent, Pietropaolo Amelia, Juliebø-Jones Patrick, Ventimiglia Eugenio, Tailly Thomas, Alexander Schmid Florian, Hunziker Manuela, Poyet Cédric, Traxer Olivier, Eberli Daniel, Keller Etienne Xavier
Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Urology, Tan Tock Seng Hospital, Singapore.
Ther Adv Urol. 2023 Jun 24;15:17562872231179332. doi: 10.1177/17562872231179332. eCollection 2023 Jan-Dec.
The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes.
IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed.
IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector ( < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS ( = 0.82, < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; < 0.001).
IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.
本研究的目的是评估软性输尿管镜检查中的一个新概念：器械死腔（IDS）。为此，在现有的软性输尿管镜中评估了各种近端工作通道连接器设计，以及占用工作通道的辅助设备的影响。
IDS定义为在近端连接器处注入以在远端工作通道尖端输送所需的生理盐水冲洗液体积。由于IDS与工作通道直径和长度、近端连接器设计以及辅助设备对工作通道的占用有关，因此也对这些参数进行了评估。
不同型号的软性输尿管镜的IDS有显著差异，从普森裸镜的1.1毫升到带有四路连接器的奥林巴斯镜的2.3毫升（<0.001）。近端连接器设计在可用鲁尔锁、阀门、密封件、角度和旋转特性的数量上表现出高度变异性。裸镜工作通道的测量长度在739至854毫米之间，且与测量的IDS显著相关（=0.82，<0.001）。将镜体与替代的辅助近端连接器连接以及将辅助设备插入工作通道会显著减少IDS（平均IDS减少0.1至0.5毫升；<0.001）。
IDS似乎是一个在软性输尿管镜未来应用中应予以考虑的新参数。对于多种临床应用而言，低IDS似乎是可取的。影响IDS的主要因素是工作通道和近端连接器设计，以及插入工作通道的辅助设备。未来的研究应阐明减少IDS如何影响冲洗液流量、肾内压力和直接镜内抽吸，以及评估最理想的近端连接器设计特性。
