Category: New Technology: Miscellaneous

MP22-6 - An Algorithmic Approach to Implementation of a Single-Use Digital Flexible Ureteroscope

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Advances in flexible ureteroscope design have led to the transition from fiberoptic to digital ureteroscopy at many institutions. While digital ureteroscopes offer enhanced optics, they are also associated with increased repair costs. The selective use of a single-use digital flexible ureteroscope for complex cases may potentially preserve the life of reusable digital ureteroscopes, and thus reduce the amount of costly repairs. We present our algorithmic approach to implementation of a single-use digital flexible ureteroscope (LithoVue™ Single-use Digital Flexible Ureteroscope, Boston Scientific Corporation, Marlborough, MA) and evaluated the impact on scope repairs.


Methods :

An IRB approved retrospective review was performed of all ureteroscopy procedures at our institution between January 1, 2016 to December 31, 2017. The algorithm for using a single-use digital flexible ureteroscope was introduced in 2017, with inclusion indications: (1) large stone burden (> 1.5 cm), (2) multiple lower pole stones (> 3), (3) extensive ureteral/renal urothelial carcinoma with expected operative duration (> 1 hour), (4) bilateral ureteroscopy, (5) stones within complex/tortuous renal anatomy, and (6) placement of ureteroscope through a trocar during robotic or laparoscopic procedures. Perioperative data were analyzed, including number of procedures, repairs, and costs.


Results : All flexible ureteroscopy procedures were performed with a digital ureteroscope. The total number of ureteroscopy procedures was 418 (272 flexible, 146 semirigid) in 2016 and 398 (318 flexible, 80 semirigid) in 2017. The total number of ureteroscope repairs was 47 (2016) and 35 (2017). The cost savings from 2016 and 2017 was 21%. A total of 63 single-use ureteroscopy procedures were performed for the indications: (1) 35, (2) 9, (3) 14, (4) 5, (5) 6, and (6) 6. Of these, 14 procedures involved 2 (n=12) or 3 (n=1) indications. The single-use ureteroscope was used in 26 additional procedures when a reusable digital ureteroscope was not available to prevent surgery delay or cancellation which translated to a net profit.


Conclusions : Implementation of an algorithm for the LithoVue™ Single-use Digital Flexible Ureteroscope resulted in a decrease in reusable digital ureteroscope repair costs. The absolute indications for use of the single-use ureteroscope were created based on our prior experience with ureteroscope damage and a review of the literature. A single-use ureteroscope may be a reasonable alternative to subjecting the more expensive reusable ureteroscope to extensive stress and damage, while potentially resulting in cost savings at high volume institutions.

Johnson Tsui

Fellow, Endourology, Laparoscopy, Robotic Surgery
Hackensack University Medical Center
Hackensack, New Jersey

John Stites

Fellow, Endourology, Laparoscopy, Robotic Surgery
Hackensack University Medical Center
Hackensack, New Jersey

Gregory Lovallo

Attending Urologist
Hackensack University Medical Center
Maywood, New Jersey

Mutahar Ahmed

Attending Urologist
Hackensack University Medical Center
Maywood, New York

Mutahar Ahmed MD FACS
Director of the Center for Bladder Cancer and Reconstructive Urologic Surgery at Hackensack University Medical Center, in Hackensack, NJ
Clinical Assitant Professor Hackensack Meridian Seton Hall School of Medicine
Clinical Assistant Professor Rutgers University School of Medicine

Michael Degen

Attending Urologist
Hackensack University Medical Center
Hackensack, New Jersey

Ravi Munver

Professor & Vice Chair
Hackensack University Medical Center
Hackensack, New Jersey