Category: Clinical Stones: Ureteroscopy

MP29-10 - Towards Respiratory Gated Retrograde Intrarenal Surgery: A Prospective Controlled Randomized Study

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

We set out to investigate whether general anesthesia with low ventilation (LV, respiratory rate ≤8/min and tidal volume <500ml) could reduce renal mobility and thereby facilitate retrograde intrarenal surgery (RIRS) compared to general anesthesia with standard ventilation (SV).


Methods :

All 60 consecutive patients who presented for RIRS in our department from September 1, 2017 to December 31, 2017 were prospectively randomized 1:1 into one group that was selected to receive SV and another that received LV. Significant factors influencing the study endpoints considered fragmentation rate (FR), removal rate (RR), processing rate (PR) and operating rate (OR), (mm3/min) were statistically analyzed.


Results :

Univariate analysis revealed that LV was a significant factor in improving all endpoints (p=0.000-0.04). Some endpoints were also affected by the stone's volume, number and density and the surgeon expertise. LV remained the single independent factor for FR, RR and PR in the multivariate analysis. LV significantly improved all four of the fellows' endpoints (p<0.05 for each) and positively influenced the expert's RR (p=0.04), PR (p=0.02) and OR (p=0.04). The performance gap between the fellows and the experts narrowed under LV. The end-tidal CO2 was significantly higher in the LV group (50 vs 36 mmHg; p=3.79E-10), however, without any clinical significance. The overall stone-free rate (97%) and complication rate (5%) were not significantly different between the two groups. The patient's anesthesia-related safety was not affected by the mode of ventilation as evidenced by no need to convert from LV to SV during the procedures.  


Conclusions :

LV during RIRS has a significant positive impact on the overall improvement of surgical performance and effectiveness. It does not negatively affect the patient's anesthesia-related safety and may contribute to considerably improving the performance of in-training endourologists.        

Vasileios Kourmpetis

Fellow in Endourology
Endourology Unit, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Dekalo Snir

Resident in Urology
Department of Urology, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Yazeed Barghouthy

Resident in Urology
Department of Urology, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Nadav Levy

Resident in Anesthesiology
Department of Anesthesiology, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Tomer Nir

Resident in Anesthesiology
Department of Anesthesiology, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Avi Beri

Attending Urologist
Department of Urology, Tel-Aviv Sourasky Medical Center
Tel-Aviv, Tel Aviv, Israel

Mario Sofer

Director of Endourology Unit
Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University
Tel-Aviv, Tel Aviv, Israel