Kim Joonhwan, Ketsuwan Chinnakhet, Song Kyu-Seob, Kim Jae-Chul, Kim Joonyeong, Park Hyeji, Kwon Dong-Soo, Lee Joo Yong, Cho Sung Yong
ROEN Surgical, Inc., Daejeon, Korea.
Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Eur J Med Res. 2025 Apr 4;30(1):232. doi: 10.1186/s40001-025-02395-9.
This study aims to investigate the improvement of stone fragmentation efficiency and safety in robotic-assisted retrograde intrarenal surgery (RIRS) that implements the respiratory motion synchronization using an in vitro model.
Laser lithotripsy was performed in three groups: manual procedure (group M), robotic procedures without respiratory synchronization (group RNR), and robotic procedures with respiratory synchronization (group RR). The study assessed fragmentation time, laser time, number of mucosal contacts, and total energy used. Two surgeons having different experience of conventional RIRS (> 2500 and < 500) were participated.
In overall results of the two surgeons, the fragmentation time significantly decreased to 74.8% in group RNR (P = 0.012) and 65.0% in group RR (P = 0.001), compared to group M. The laser time was significantly shorter in group RR compared to the group M (P = 0.003). The number of mucosal contacts was significantly reduced to 37.4% in group RNR (P = 0.048) and it was 34.0% in group RR, compared to group M. The total energy significantly decreased in group RR compared to group M (P = 0.011). There were no significant differences between group RR and RNR across all outcomes in the overall results of the two surgeons. For less experienced surgeon, the fragmentation time was significantly shorter in group RR compared to group RNR (P = 0.013).
Robotic-assisted RIRS resulted in reduced fragmentation time, laser time, mucosal contacts, and total energy compared to manual RIRS during laser lithotripsy. The incorporation of respiratory synchronization in robotic-assisted RIRS reduced laser time compared to manual RIRS and shortened the fragmentation time compared to the robotic-assisted RIRS without respiratory synchronization, particularly for less experienced surgeon. These initial results demonstrated the feasibility of robotic-assisted RIRS with respiratory synchronization, highlighting its potential to improve procedural efficiency and safety.
本研究旨在使用体外模型，探讨在实施呼吸运动同步的机器人辅助逆行肾内手术（RIRS）中结石破碎效率和安全性的改善情况。
激光碎石术在三组中进行：手动操作组（M组）、无呼吸同步的机器人操作组（RNR组）和有呼吸同步的机器人操作组（RR组）。该研究评估了破碎时间、激光照射时间、黏膜接触次数和总能量消耗。两名具有不同传统RIRS经验（>2500例和<500例）的外科医生参与了研究。
在两名外科医生的总体结果中，与M组相比，RNR组的破碎时间显著缩短至74.8%（P = 0.012），RR组为65.0%（P = 0.001）。与M组相比，RR组的激光照射时间显著更短（P = 0.003）。与M组相比，RNR组的黏膜接触次数显著减少至37.4%（P = 0.048），RR组为34.0%。与M组相比，RR组的总能量显著降低（P = 0.011）。在两名外科医生的总体结果中，RR组和RNR组在所有结果方面均无显著差异。对于经验较少的外科医生，RR组的破碎时间比RNR组显著更短（P = 0.013）。
与手动RIRS激光碎石术相比，机器人辅助RIRS导致破碎时间、激光照射时间、黏膜接触次数和总能量减少。与手动RIRS相比，在机器人辅助RIRS中加入呼吸同步可减少激光照射时间，与无呼吸同步的机器人辅助RIRS相比可缩短破碎时间，特别是对于经验较少的外科医生。这些初步结果证明了机器人辅助RIRS与呼吸同步的可行性，突出了其提高手术效率和安全性的潜力。
