Category: Stones: Ureteroscopy

VS1-10 - Setup of the operating room for ureteroscopy

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : A dedicated endourology operating room is required when performing ureteroscopy. We aimed to describe how the setup is performed in a high volume center with more than 1000 ureteroscopic procedures per year.


Methods :

The setup of the operating room is unaltered when performing a flexible or semirigid ureteroscopy at the left or right side.


Results :

Before bringing the patient to the operating room, all necessary materials and instruments are supplied. The patient is placed in a lithotomy position. Although spinal anesthesia is a viable option, we prefer general anesthesia for two reasons. Firstly, mechanical ventilation can be stopped temporarily as needed. Secondly, the time frame for spinal anesthesia can be exceeded for larger stones, requiring a second general anesthesia to finish the procedure. The endoscopy tower is positioned on the right side of the patient with the screen centered over the right half side. Several irrigation systems can be used. We prefer to use an endo-irrigation device, since it delivers steady and precise liquid flow. The fluoroscopy C-arm is positioned on the left side of the patient. The image intensifier should be placed as close to the patient as possible to maximize the intensity of radiation intercepted by the detector and to reduce the the patient’s radiation exposure. Before setting the table, we patch adhesive tape in order to prevent instrument sliding. The worktop of the table is elevated to the level of the patient’s genital area. Before instruments are placed on the table, the inguinogenital area is extensively disinfected. Afterwards, the patient and also the C-arm is draped. Then, the tube is connected between the pouch of the drape and the surgical suction pump. A waste bin pushes the aspiration tube away to avoid disturbances of the tube during the intervention. Afterwards, the pouch is fixed to the table with adhesive tape.The camera drape, light cable, irrigation tubing and cystoscope are supplied. If necessary, a stiff straight Terumo guidewire of 150 cm is placed on the table as well. The camera is draped, the light cable is connected and the irrigation tubing is linked to the endo-irrigation device. We always start by performing a cystoscopy. When a laser fibre is used, the laser machine is put a few centimeters away from the table in order to avoid people walking between the laser machine and the table.


Conclusions :

The strategic placement of the operating room equipments minimizes procedural time and improves intuitive control by both the surgeon and the operating room personnel. Standardising the operating room setup definitely facilitates endourology procedures and increases safety, convenience and economy.

Maria Rodriguez-Monsalve Herrero

Urologist
University Hospital Puerta de Hierro, Majadahonda.
Majadahonda, Madrid, Spain

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France