SURE (Steerable Ureteroscopic Renal Evacuation) Procedure for the Treatment and Elimination of Kidney Stones "Presentation" - Thomas Mueller
November 19, 2024
At the 2024 LUGPA annual meeting, Thomas Mueller presents the SURE Procedure with CVAC System, a novel ureteroscopic technology combining microjet irrigation and dynamic aspiration. He demonstrates improved stone clearance rates, visualization, and fragment removal compared to standard ureteroscopy through clinical cases and ASPIRE study data.
Biographies:
Thomas Mueller, MD, Urologist, New Jersey Urology, Voorhees, NJ
Biographies:
Thomas Mueller, MD, Urologist, New Jersey Urology, Voorhees, NJ
Read the Full Video Transcript
Thomas Mueller: Hello, my name is Thomas Mueller. I'm from New Jersey Urology and I'm here to present on the SURE Procedure, Steerable Ureteroscopic Renal Evacuation for the treatment and elimination of kidney stones. Two disclosures: one for Calyxo as well as for Teleflex. Now presently there's an unmet clinical need for residual fragments. Why is stone-free status the best for patients? Well, residual fragments are associated with a 20 to 44% rate of complications and stone events that include but are not limited to stone regrowth, emergency room visits, hospitalizations, infections, as well as additional procedures. So therefore, there remains a need for a more reliable and effective way to remove fragments after ureteroscopy and laser lithotripsy and deliver a surgically stone-free outcome for our kidney stone patients.
I introduce the CVAC System, which is a stone clearance solution. It's an all-in-one system that includes a very nice flexible ureteroscope that can perform laser lithotripsy. It has microjet irrigation, as well as dynamic aspiration, and it does collect the stones in one nice device at the very end of the procedure. Now this is more than just suction with standard ureteroscopy. This is microjet irrigation that stabilizes a larger stone and optimally moves smaller fragments for popcorning. It does have simultaneous flow in order to keep the visualization as clear as possible. It's more than just suctioning as well as standard ureteroscopy; it is microjet irrigation. It is simultaneous flow. It also has a larger lumen to get larger fragments up to two millimeters in size, to produce an effective and efficient aspiration system.
As you can see on this benchtop model, with this simultaneous flow, it leads to a much clearer visual field. Standard ureteroscopy is often clouded by the smaller fragments, whereas with the CVAC system, with its dynamic aspiration, it does maintain a much clearer visual field for optimal treatment of our kidney stones for our patients.
What I would like to present next is a 15-millimeter stone in the renal pelvis. This is a patient that originally presented with an obstruction at her UPJ. The patient was previously septic, for which she was stented prior to this procedure. After the sepsis and UTI had resolved, the patient presents for laser lithotripsy, ureteroscopy, and CVAC. As we can see, we're utilizing a laser fiber in dusting settings to try to get the fragments as small as possible. That small dust that you see is actively being aspirated through the system to keep the field as clear as possible. What you can also identify is that the microjet irrigation stabilizes the kidney stone when it's larger, but it also helps to move the smaller fragments, and this is what creates an ideal popcorning to increase the contact of those stones to the laser fiber to get those fragments as small as possible.
After getting all of the fragments approximately two millimeters or less, we can then have active aspiration, and what we mean by that is we can start to remove those stone fragments through the CVAC system, to provide as close to a surgically stone-free status as possible. With each successive aspiration, you can see less and less stone that is present within the upper pole of this patient's kidney. And with final confirmation, you can identify 100% stone clearance visually from the surgeon. This was performed in 46 minutes from intubation to extubation on a 1.5-centimeter stone.
There is clinical data from the ASPIRE Study, which is level one evidence. It's the first study to standardize the imaging modality of CAT scans and post-op imaging period of 30 days in a prospective multicenter kidney stone procedure. It did show superior 97% mean stone clearance, as well as showing lower healthcare consumption when compared to standard ureteroscopy and laser lithotripsy.
Now to conclude, if we focus on complete clearance of stone from the renal pelvis and ureter as our goal in kidney stone surgery, we have to look at all the options that are out there, and the CVAC system is unique in the fact that it's both efficient as well as effective, raising the standard of what we presently can perform with the standard techniques prior to the CVAC system. This is the conclusion of this presentation and I greatly thank you for your time. Have a great afternoon at LUGPA.
Thomas Mueller: Hello, my name is Thomas Mueller. I'm from New Jersey Urology and I'm here to present on the SURE Procedure, Steerable Ureteroscopic Renal Evacuation for the treatment and elimination of kidney stones. Two disclosures: one for Calyxo as well as for Teleflex. Now presently there's an unmet clinical need for residual fragments. Why is stone-free status the best for patients? Well, residual fragments are associated with a 20 to 44% rate of complications and stone events that include but are not limited to stone regrowth, emergency room visits, hospitalizations, infections, as well as additional procedures. So therefore, there remains a need for a more reliable and effective way to remove fragments after ureteroscopy and laser lithotripsy and deliver a surgically stone-free outcome for our kidney stone patients.
I introduce the CVAC System, which is a stone clearance solution. It's an all-in-one system that includes a very nice flexible ureteroscope that can perform laser lithotripsy. It has microjet irrigation, as well as dynamic aspiration, and it does collect the stones in one nice device at the very end of the procedure. Now this is more than just suction with standard ureteroscopy. This is microjet irrigation that stabilizes a larger stone and optimally moves smaller fragments for popcorning. It does have simultaneous flow in order to keep the visualization as clear as possible. It's more than just suctioning as well as standard ureteroscopy; it is microjet irrigation. It is simultaneous flow. It also has a larger lumen to get larger fragments up to two millimeters in size, to produce an effective and efficient aspiration system.
As you can see on this benchtop model, with this simultaneous flow, it leads to a much clearer visual field. Standard ureteroscopy is often clouded by the smaller fragments, whereas with the CVAC system, with its dynamic aspiration, it does maintain a much clearer visual field for optimal treatment of our kidney stones for our patients.
What I would like to present next is a 15-millimeter stone in the renal pelvis. This is a patient that originally presented with an obstruction at her UPJ. The patient was previously septic, for which she was stented prior to this procedure. After the sepsis and UTI had resolved, the patient presents for laser lithotripsy, ureteroscopy, and CVAC. As we can see, we're utilizing a laser fiber in dusting settings to try to get the fragments as small as possible. That small dust that you see is actively being aspirated through the system to keep the field as clear as possible. What you can also identify is that the microjet irrigation stabilizes the kidney stone when it's larger, but it also helps to move the smaller fragments, and this is what creates an ideal popcorning to increase the contact of those stones to the laser fiber to get those fragments as small as possible.
After getting all of the fragments approximately two millimeters or less, we can then have active aspiration, and what we mean by that is we can start to remove those stone fragments through the CVAC system, to provide as close to a surgically stone-free status as possible. With each successive aspiration, you can see less and less stone that is present within the upper pole of this patient's kidney. And with final confirmation, you can identify 100% stone clearance visually from the surgeon. This was performed in 46 minutes from intubation to extubation on a 1.5-centimeter stone.
There is clinical data from the ASPIRE Study, which is level one evidence. It's the first study to standardize the imaging modality of CAT scans and post-op imaging period of 30 days in a prospective multicenter kidney stone procedure. It did show superior 97% mean stone clearance, as well as showing lower healthcare consumption when compared to standard ureteroscopy and laser lithotripsy.
Now to conclude, if we focus on complete clearance of stone from the renal pelvis and ureter as our goal in kidney stone surgery, we have to look at all the options that are out there, and the CVAC system is unique in the fact that it's both efficient as well as effective, raising the standard of what we presently can perform with the standard techniques prior to the CVAC system. This is the conclusion of this presentation and I greatly thank you for your time. Have a great afternoon at LUGPA.