(UroToday.com) The WCET Annual meeting in San Diego, California, contained a session highlighting numerous studies regarding kidney stones and infection. Dr. Thomas Chi and his colleagues from the University of California, San Francisco presented a study giving insight into the possible future regarding Percutaneous nephrolithotomy (PCNL) and Ureteroscopy (URS). Dr. Chi prefaced this study by asking how many people in the audience have ever played a video game, to which almost all raised their hands. The link between a video game and this study is the design of the Monarch ® platform that is designed to make the physical and ergonomic burden of PCNLs and URSs easier.
This study was conducted in 12 porcine models that in an IACUC approved study. Dr. Chi and colleagues used 6 pigs for a bilateral URS and 6 for bilateral PCNL. During these pig studies, the team compared the monarch ® platform vs. conventional devices such as the LithoVue for URS and STORZ nephroscope and LithAssist for PCNLs.
In the Monarch ® Platform Devices portion of the study, the equipment included a controller and a ureteroscope for URS’s and a controller, a ureteroscope, and mini-PCNL suction catheter for PCNLs (Figure 1). Ease of completion for URS was assessed through ureter and kidney surveillance, manipulation of the ureteroscope and basket within the upper and lower pole, and retraction of the ureteroscope.
For PCNL, a handheld controller was used to simultaneously control retrograde ureteroscope and an anterograde suction catheter. The ease of completion was assessed for gaining access and dilating the percutaneous tract, placement of renal access sheath, manipulating the suction device, and controlling irrigation and aspiration.
Figure 1. Methods used to compare conventional devices vs monarch ® robotic systems
Figure 3. Ease of completion comparing both conventional vs Monarch ® robotic devices in URS and PCNL task completions.
What the UCSF team observed was that there were no clinically significant differences between conventional devices and the Monarch ® robotic devices, while also observing no safety events. They concluded that the Monarch ® robotic devices can complete essential procedural tasks of URS and PCNL with easy to control instruments such as the video game analogous controller used to manipulate the ureteroscope and basket with analog sticks (Figure 3). After the presentation, conversation arose surrounding the use of the monarch ® robotic devices, with the audience asking about how it is set up time in the OR. Dr. Chi replied to this by mentioning that it is still being worked out, but this is an aspect that takes time to learn as new technology always has a learning curve, Dr. Chi mentioned a brief history to back this claim up. A member of the audience then proceeded to ask Dr. Chi where he sees the future of this to which he replied that he hopes that surgeries for 3-5 cm stones can be done more safely and hopes to push the limits of how URS are done. Dr. Chi ended his discussion with the audience by stating that further studies should be done on human subjects to understand the capacity of this technology further fully. We are constantly seeing innovation in medicine in hopes of easing the burden that arises when treating patients. Here, we saw promising technology that is intended to make specific urological surgeries easier on urologist while also resembling a relatively new common hobby, video games.
Presented by: Thomas Chi, MD – Professor of Urology, Associate Chair for Clinical Affairs, Kutzmann Endowed Professor in Clinical Urology, University of California, San Francisco
Written by: Paul Piedras, BS, University of California Irvine, @piedras_paul on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.