Category: New Technology: Stones
Introduction & Objective :
Ureteroscopic stone manipulation and retrieval typically requires two experienced individuals: one to drive the ureteroscope and a second to manipulate the stone basket or grasper. Recently, a retrieval deployment device (RDD) has been developed which allows the primary surgeon to activate the stone basket while simultaneously controlling the ureteroscope. We performed a study to characterize the procedure time and ergonomics of this approach.
Methods : We performed a three-arm evaluation of the ergonomics of flexible ureteroscopy utilizing a simulation model of stone retrieval. In Arm 1, two experienced operators performed stone manipulation and retrieval, one managed the ureteroscope and the other managed the retrieval tool. In Arm 2, a single operator managed both the ureteroscope and retrieval tool. In the Arm 3, a single operator managed the ureteroscope conventionally, but utilized the novel RDD (EmPower™, Boston Scientific, Marlborough, MA) (Figure) to control the retrieval tool. Fifteen tasks were performed for each arm and median procedure time was calculated. Electromyography was used to compare and quantify cumulative muscular workload (CMW) and average muscular work per second (AWS) of the right and left thenar, flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), biceps, triceps, and deltoid muscles.
Results : Median procedure time was significantly improved with the RDD when compared to single surgeon URS (29.4 vs. 51.3 seconds, p Two surgeon URS also was significantly faster than single surgeon URS (27.9 vs. 51.3 seconds, p CMW was similar between RDD and two surgeon URS but both had decreased CMW across all muscle groups compared to single surgeon URS (p < 0.01). AWS was overall similar between RDD and two-surgeon URS across all muscle groups. RDD had significantly improved AWS compared to single-surgeon URS specifically in the thenar, FCU, and ECU muscles (<0.05) of the dominant arm.
Conclusions : The novel RDD, as tested, permitted a single surgeon to perform flexible ureteroscopy with stone manipulation and retrieval using less muscular workload than single surgeon URS and similar workload to two surgeon URS. Task completion time was also improved with RDD over the single surgeon model and similar to the two surgeon model.
Kevin Koo– Fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland
Gregory Joice– Johns Hopkins Hospital, Baltimore, Maryland
Wesley Ludwig– Baltimore, Maryland
Zeyad Schwen– Johns Hopkins Brady Urological Institute, Baltimore, Maryland
Michael Gorin– Assistant Professor of Urology, Oncology, and Radiology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Brian Matlaga– Baltimore, Maryland
Johns Hopkins University School of Medicine
Kevin Koo, MD, MPH, MPhil, is a fellow in endourology and minimally-invasive urological surgery at the Brady Urological Institute, Johns Hopkins University School of Medicine. He serves as national chair of the AUA Residents and Fellows Committee and is the AUA H. Logan Holtgrewe Legislative Fellow. He is a graduate of the Yale School of Medicine and completed residency at Dartmouth-Hitchcock Medical Center.
Assistant Professor of Urology, Oncology, and Radiology
The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine