Category: New Technology: Stones
Introduction & Objective :
To evaluate our experience in retrograde intrarenal surgery using the Avicena Roboflex System and stratify intra- and postoperative complications.
From June 2014 until December 2017 a total of 208 patients (123 men and 85 women) suffering from nephrolithiasis underwent robotic retrograde intrarenal stone treatment in our Center using the Avicenna Roboflex robotic device. We analyzed the preoperative and the operative data from the patients. Intraoperative complications were recorded according to modified Satava classification system and postoperative complications based on Clavien classification.
The mean age was 51.89 yr (range: 17-82 yr) and the mean BMI 28.1 (range: 17.6-49.5). The mean stone burden was: 2957 mm3 (range: 400-4100 mm³). The mean Hounsfield in CT Kidney was 736 (range: 276-1423). The mean number of stones in the kidney was 1.98 (range: 1-9). The majority of patients (98%) were pre-stented. We used access sheath in all patients. 87.01% of patients (181) underwent Stone Fragmentation.
The statistical analysis from the operative parameters showed that the mean operative time was 85.21 min. (range: 10-263), the mean robot docking time 4,72 min (range: 1-17), the mean console time 68.60 min (10-229) and mean console time to Stone contact was 5.91 min (30 sec-20 min). Mean fragmentation time was 22.49 min. (range: 1-129 min.) corresponding to a mean Stone-clearance rate 44.8 mm³/min. Mean remove fragments from the Kidney with basket was 20.49 min (range: 1-125).
The overall incidence of intraoperative complications was 9.13 %. The most common complications were mucosal injury (4.8%) and Stein migration (1.92%). According to modified Satava classification system, there were 6.73 % grade 1; 1,44 % grade 2a; 0,9 % grade 2b.
In relation with postoperative complications 2 patients died; one due to severe sepsis and the other on 3nd postoperative day time due to Myocardial Infarction. 4 patients developed complications of Grade II (1 patient subcapsular Kidney Hematoma, 1 blood transfusion and 2 fever without Sepsis) and 1 complication Grade IIIB (urine leakage-U/S guided drainage).
After treatment the stone free rate (SFR) was 94%. DJ stents were placed in 199 patients, 91 DJ-stents were removed in the first postoperative day, 108 DJ-stents in a short period of 7 to 14 days.
Roboflex Avicenna provides a suitable and a safe platform for robotic FURS. The new robotic device provides a non exhausting environment for the surgeon especially during long FURS. Ongoing refinement is likely to expand the role of this technology in retrograde intrarenal surgery in the near future.
Nikolaos Charalampogiannis– Specialist Registrar, SLK Kliniken am Gesundbrunnen Department of Urology , Heilbronn, Baden-Wurttemberg, Germany
Jan Torben Klein– Ulm, Baden-Wurttemberg, Germany
Marcel Fiedler– Heilbronn, Baden-Wurttemberg, Germany
Ali Gözen– Heilbronn, Baden-Wurttemberg, Germany
Hagen Weiss– Heilbronn, Baden-Wurttemberg, Germany
Philip Rieker– Heilbronn, Baden-Wurttemberg, Germany
Walter Scheitlin– Heilbronn, Baden-Wurttemberg, Germany
Spyros Achinas– Groningen, Groningen, Netherlands
Jens Rassweiler– Heilbronn, Baden-Wurttemberg, Germany
SLK Kliniken am Gesundbrunnen Department of Urology
Heilbronn, Baden-Wurttemberg, Germany
Since 01/2016 Specialist Registrar in Department of Urology, SLK Kliniken am Gesundbrunnen Heilbronn
- 10/2012 - 12/2015 Specialist Registrar in Department of Urology, Diakonie Krankenhaus Schwäbisch Hall.
- 03/2012 - 10/2012 Clinical Fellowship in Endourology and Laparoscopy, Department of Urology, Klinikum Sindelfingen-Böblingen
- 06/2007 - 08/2011 Urology training in Hellenic Red Cross Hospital “Korgialenio-Benakeio”, Athens, Greece
- 09/2005 - 12/2006 General Surgery General Hospital, Kastoria, Greece
Topics of special interest
- Urinary Stone disease (evaluation, treatment, prevention)
- Uro-oncology including medical tumor therapy
- Inontinence and Urodynamic
- 1st prize for the best Poster Presentation, EAU 4th South Eastern European Meeting (SEEM), 2008
(Caspase-8 and P-P38 expression in clear cell renal cell carcinoma)
- 1st Prize for the Best Scientific Poster Presentation, 13th Greek-German Urological Congress, 2010.
(The Effect of Theophylline on Calcium Oxalate Formation in Vitro)
- 2nd Prize for the Best Scientific DVD Presentation, 20th Hellenic Urological Congress, 2010
(Restoration of complicated urethrovaginal fistula with the use of the bulbocavernosous muscle).
- 1st Prize for the Best Scientific Poster Presentation, 4th Scientific Meeting Hellenic Urological Association-Department of Urogenital Oncology 2011.
(Comparative Study of Partial Nephrectomy with or without Iscaemia).
- 1st prize for the best Poster Presentation, 15th Greek-German Urological Congress, 2013.
(Association of urinary stone composition with the clinical characteristics of the patients: Analysis of our experience).
Memberships in Scientific Societies:
- Greek Society of Urology (EOE)
- German Society of Urology (DGU)
- European Association of Urology (EAU)
- Greek-Germay Society of Urology (GDGU)
- German Society for Ultrasound in Medicine (DEGUM)