Vergamini Lucas B, Whiles Bristol B, McMahon Amber, Creswell Michael, Starkey Jared, Smith Jill, Sardiu Mihaela E, Neff Donald A, Duchene David A, Molina Wilson R
Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA.
Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
World J Urol. 2025 May 8;43(1):284. doi: 10.1007/s00345-025-05629-x.
To address the literature paucity regarding the surgical outcomes with the utilization of vacuum-assisted renal access sheath (VA-RAS) versus usual miniaturized renal access sheath (RAS) in mini-percutaneous nephrolithotomy (mini-PCNL).
Retrospective cohort data for patients who underwent supine mini-PCNL with the HoYAG laser platform (Lumenis Pulse P120H™, 120 W, Boston Scientific) between 08/2021 and 07/2024. Exclusion criteria included patients with urinary diversion, cases using any other form of stone fragmentation but laser, and those with ureteral stones. VA-RAS (ClearPetra™, MicroTech Endoscopy, China) and RAS (MIP-M, Karl Storz, Germany) were compared. Stone-free rate (SFR) was assessed by CT scan performed on the first postoperative day and presented as: absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm.
A total of 111 patients met the study criteria, of which VA-RAS was used for 57 patients (51.4%). Despite higher stone volume in VA-RAS group, there was no difference in total operative time. Nevertheless, laser ablation efficiency and time to clear 1 cm was lower in VA-RAS group. Overall, there was no difference in SFR between VA-RAS and RAS (no fragments: RR 1.3, CI 95% 0.9-1.8, p = 0.11; fragments < 2 mm: RR 1.1, CI 95% 0.8-1.4, p = 0.68; fragments < 4 mm: RR 1.2, CI 95% 0.9-1.5, p = 0.09).
We observed an equivalent postoperative SFR, total operative time and laser ablation speed when comparing VA-RAS and RAS in mini-PCNL. However, we observed a higher laser ablation efficiency and lower time clear 1 cm of stone with VA-RAS group.
解决关于在微创经皮肾镜取石术（mini-PCNL）中使用真空辅助肾穿刺鞘（VA-RAS）与传统小型肾穿刺鞘（RAS）的手术效果的文献匮乏问题。
回顾性队列研究数据来自于2021年8月至2024年7月间采用钬激光平台（Lumenis Pulse P120H™，120W，波士顿科学公司）进行仰卧位mini-PCNL的患者。排除标准包括尿路改道患者、使用除激光以外任何其他形式结石破碎方法的病例以及输尿管结石患者。对VA-RAS（ClearPetra™，迈瑞医疗内镜，中国）和RAS（MIP-M，卡尔史托斯，德国）进行比较。结石清除率（SFR）通过术后第一天进行的CT扫描评估，定义为：无结石碎片、无大于2mm的碎片或无大于4mm的碎片。
共有111例患者符合研究标准，其中57例（51.4%）使用了VA-RAS。尽管VA-RAS组的结石体积更大，但总手术时间并无差异。然而，VA-RAS组的激光消融效率和清除1cm结石的时间更低。总体而言，VA-RAS和RAS之间的SFR没有差异（无碎片：RR 1.3，95%CI 0.9 - 1.8，p = 0.11；碎片<2mm：RR 1.1，95%CI 0.8 - 1.4，p = 0.68；碎片<4mm：RR 1.2，95%CI 0.9 - 1.5，p = 0.09）。
在mini-PCNL中比较VA-RAS和RAS时，我们观察到术后SFR、总手术时间和激光消融速度相当。然而，我们观察到VA-RAS组的激光消融效率更高，清除1cm结石的时间更短。
