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      Comparison of New Single-Use Digital Flexible Ureteroscope Versus Nondisposable Fiber Optic and Digital Ureteroscope in a Cadaveric Model

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      Author(s): , MD, FEBU 1, , 2 , , MD 2 , , MD 3 , , MD, MSc 2 , , MD 1 , , MD 2 ,
      Publication date PMC-release:
      Journal: Journal of Endourology
      Publisher: Mary Ann Liebert, Inc.

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          Abstract

          Purpose: To evaluate LithoVue, the new single-use digital flexible ureteroscope, in a human cadaveric model and compare it with a nondisposable fiber optic and digital flexible ureteroscopes.

          Materials and Methods: LithoVue, a conventional fiber optic, and digital flexible ureteroscopes were each tested in four renal units of recently deceased female cadavers by three surgeons. The following parameters were analyzed: accessibility to the kidney and navigation of the entire collecting system with and without ureteral access sheath (UAS), lower pole access measuring the deflection of the ureteroscope with the working channel empty, and with inside two different baskets and laser fibers. A subjective evaluation of maneuverability and visibility was assessed by each surgeon at the end of every procedure.

          Results: Kidney access into the Renal unit 1 was not possible without UAS for all ureteroscopes because of noncompliant ureter at the level of sacroiliac joint. The reusable digital ureteroscope was unable to reach one calix of the lower pole and one calix of the upper pole (Renal units 2 and 3) without UAS placement. Lower pole access with baskets and laser fibers was possible for each ureteroscope after UAS placement. No statistically significant differences were detected in angle deflection between ureteroscopes. The digital ureteroscope was preferred for visibility in all procedures: LithoVue for maneuverability in six procedures, fiber optic in five procedures, and the digital ureteroscope in one procedure.

          Conclusions: LithoVue seems to be comparable with conventional ureteroscopes in terms of visibility and manipulation into the collecting system in fresh human cadavers. Further studies in humans are needed to determine the clinical value of this new instrument.

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          Frequency of ureteroscope damage seen at a tertiary care center.

          Robert I. Carey, Christopher S Gomez, Giuseppe Maurici … (2006)
          There is controversy regarding ureteroscope durability. Little is known regarding the subsequent durability of a flexible ureteroscope after major damage has been incurred and the ureteroscope has been repaired. Maintenance and repair are associated with significant cost. We reviewed and assessed the frequency and cause of ureteroscope damage at our medical center. From December 2001 we prospectively recorded the specific use of all ureteroscopes and any resultant damage at a single tertiary care institution. We then reviewed a total of 601 ureteroscopic cases involving 654 semirigid and flexible ureteroscope uses from December 2001 to November 2004. Cases were performed by multiple residents and fellows under the supervision of 3 attending urologists (CML, RJL and VGB). Retrograde and antegrade cases involving stones, urothelial carcinoma, strictures and diagnostic evaluations were included. Repairs for the respective ureteroscopes were performed by the original manufacturer. A total of 53 reports of damage (8.1% of total uses) were recorded. Major damage when the scope was deemed unusable and required repair was seen in 39 cases (6.0%). Four newly purchased flexible ureteroscopes were entered into the study and they provided 40 to 48 uses before the initial repair was needed. After these new ureteroscopes underwent comprehensive repair for major damage they averaged only 11.1 uses (median 8) before needing repair again. Older model ureteroscopes that underwent repair before being entered into our study averaged between 4.75 and 7.7 uses before being sent for subsequent repair. Of the total of 39 breakages 39 for which ureteroscopes were sent for repair 14 (35.9%) were the result of errant laser firing, 11 (28.2%) were the result of excessive torque, 8 (20.5% 8) were the result of decreased flexion in the distal tip or another loss of function without obvious iatrogenic cause, 3 (7.7%) were the result of multifocal catastrophic damage involving laser firing and excessive torque, and 3 (7.7%) were the result of cleaning and processing outside of the ureteroscopy suite. The most important risk factors for predicting the number of uses expected from a ureteroscope at our institution is ureteroscope age and whether the ureteroscope has undergone comprehensive repair as the result of prior damage. Our analysis suggests that after damage occurs to a ureteroscope more damage occurs with greater frequency. The cost of maintaining previously used ureteroscopes should be carefully considered in comparison to the cost of purchasing a new ureteroscope.
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            Durability of flexible ureteroscopes: a randomized, prospective study.

            Manoj Monga, Sara Best, Ramakrishna Venkatesh … (2006)
            We performed a randomized, prospective, multi-institutional study evaluating the durability of commercially available flexible ureteroscopes. A total of 192 patients were randomized to the use of 7 less than 9Fr flexible ureteroscopes, including the Storz 11274AA and Flex-X, the ACMI DUR-8 and DUR-8 Elite, Wolf models 7330.170 and 7325.172, and the Olympus URF-P3. Information about total and lower pole use time, the number and method of ureteroscope insertion, and they type and duration of accessory instrumentation was recorded. Surgeons were asked to rate the visibility and maneuverability of the instrument on a scale of 0-poor to 10-excellent. The indication for ureteroscopy was upper tract calculi in 87% of cases. Of ureteroscope insertions 97% were performed through an access sheath. The average of number of cases before repair ranged from 3.25 for the Wolf 7325 to 14.4 for the ACMI DUR-8 Elite. Average ureteroscope operative time was statistically longer for the DUR-8 Elite (494 minutes) than for the Flex-X (p = 0.047), and the Wolf 7325 and 7330 (p = 0.001 and 0.001, respectively). Duration of use before repair for the URF-P3 (373 minutes) was statistically longer than for the Wolf 7325 and 7330 (p = 0.016 and 0.017, respectively). Minutes of use with an instrument in the working channel were significantly more with the DUR-8 Elite and the URF-P3 than the Wolf 7330 (p = 0.017 and 0.008) and 7325 (p = 0.012 and 0.005, respectively). The ureteroscope that experienced the greatest average duration of lower pole use was the URF-P3, while the shortest was the Wolf 7325 (103 vs 20 minutes, p = 0.005). Average minutes of laser use before breakage was significantly longer for the DUR-8 Elite than for the Wolf 7325 (110 vs 21 minutes, p = 0.021) and 7330 (24 minutes, p = 0.025). Currently available less than 9Fr flexible ureteroscopes remain fragile instruments. The DUR-8 Elite and Olympus URF-P3 proved to be the most durable devices.
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              New-generation flexible ureterorenoscopes are more durable than previous ones.

              Francis Dubosq, Karim Jamali, Olivier Traxer … (2006)
              To determine the deterioration in the maximal active deflection and flow capabilities of a new-generation flexible ureteroscope (URS). We performed 50 ureterorenoscopies using the same URS: a Karl Storz 11278 AU1 Flex-X, which is capable of a 270 degree active deflection in the ventral and dorsal directions. Postoperatively, we evaluated the maximal active ventral and dorsal deflection, irrigation flow at 100 cm H2O, and the number of broken optical fibers. The URS was used for a total of 76 hours, 15 minutes (average 95 minutes per procedure). The maximal ventral deflection had deteriorated from 270 degrees to 208 degrees at the last procedure. The maximal dorsal deflection had decreased from 270 degrees to 133 degrees. The irrigation flow at 100 cm H2O had decreased from 50 mL/min initially to 40 mL/min at the last procedure. The number of broken image fibers had reached six at the 50th procedure. One repair was necessary at the 50th procedure because of a laser perforation of the working channel. The need for repair occurs less frequently with the new-generation of URSs, especially when they are used by an experienced endourologist. In the future, improvements in the durability of the flexible URS will still be key for widespread use of the technique and especially to limit damage by the laser to the working channel.
              Article 0 comments Cited 26 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Endourol
                Journal ID (iso-abbrev): J. Endourol
                Journal ID (publisher-id): end
                Title: Journal of Endourology
                Publisher: Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Print): 0892-7790
                ISSN (Electronic): 1557-900X
                Publication date (Print): 01 June 2016
                Publication date PMC-release: 01 June 2016
                Volume: 30
                Issue: 6
                Pages: 655-659
                Affiliations
                [ 1 ]Department of Urology, Ville Turro Division, IRCCS San Raffaele Scientific Institute , Milan, Italy.
                [ 2 ]Department of Urology, Tenon Hospital , Paris, France.
                [ 3 ]Department of Surgery/Urology, Denver Health , Denver, Colorado.
                Author notes
                Address correspondence to: Olivier Traxer, MD, Department of Urology, Tenon Hospital 4 rue de la CHINE, Paris 75020, France

                E-mail: olivier.traxer@ 123456tnn.aphp.fr
                Article
                Publisher ID: 10.1089/end.2016.0051
                DOI: 10.1089/end.2016.0051
                PMC ID: 4913498
                PubMed ID: 27084572
                SO-VID: 32b7e577-3cbc-4f74-b9c5-21a40cff8542
                Copyright © © Silvia Proietti et al. 2016; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Page count
                Figures: 3, Tables: 3, References: 16, Pages: 5
                Categories
                Subject: Ureteroscopy and Percutaneous Procedures

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