Presented by: Wojciech Krajewski Prof., MD, PHD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Introduction

The ILY robotic flexible ureteroscope has been introduced in retrograde intrarenal surgery (RIRS) in order to improve intraoperative ergonomics, distance operator from ionizing radiation and shorten the learning curve. The robot is a remotely controlled ureteroscope holder that allows transmission of all basic flexible ureteroscopy (fURS) movements. We aimed to assess the clinical performance and feasibility of the ILY robot during RIRS and combined endoscopic procedures.

Materials

The RIRS procedures were performed using the ILY robotic arm in 57 adult patients (46 RIRS, 11 endoscopic combined intrarenal surgeries (ECIRS)) from 2022 to 2023 by an experienced endourological team. The staff have been adept in manipulating the device’s controller (commercially available gaming console device) before the onset of the study. First 5 cases performed by our team were excluded from the analysis, as some training was necessary to get familiar with the device. Hawk flexible ureteroscopes and Quanta CyberHo 60w holmium laser with 272 micrones fiber were used during every RIRS.

Results

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In order to assist calibration, draping and docking of the device one additional briefly trained person (nurse/technician) was needed. Turning on and calibration of the device took approximately 100 s. Average draping time was 93 s using original ILY drapes (range 69-229) and 47 s (range 23-71) using classic drapes designed for C-arm covering. Mean docking time was 73 s (range 32-124) in procedures with ureteral access sheath (UAS) and 61 s (range 30-99) in procedures without it. The undocking took less than 20 s in every case.  Mean age of patients included in the study was 46 years (range 18-82 years). For RIRS cases average stone size was 1.3 cm (range 0.8-2.3 cm), while for ECIRS procedures the mean biggest stone size was 1.9 cm (range 1.1-5.6). 37 (65%) patients were pre-stented (32 RIRS and 5 ECIRS cases). Moreover, 34 (73.9%) RIRS and 4 (36.4%) ECIRS procedures were performed with UAS, the majority in males. 10.7Fr UAS was used in all patients. Average procedure time was 63 min (range 15-91 min) for RIRS (counting from the first insertion of the scope into the bladder to the bladder catheterisation) and 55 min (range 32-83 min) for ECIRS (counting from the first insertion of the nephroscope into the kidney to the bladder catheterisation). Endoscopically proven stone free rate (defined as no visible residual fragments bigger than 2 times laser fiber diameter) was achieved in 37 (80.4%) RIRS and 10 (90.9%) ECIRS patients. 17 (36.9%) RIRS and 8 (72.7%) ECIRS procedures required robot undocking and conversion in order to perform basketing and stone fragments retrieval/transposition.

Conclusion

The use of ILY robot during endourological procedures is feasible and urologists that are familiar with the device controller do not require extensive training. The time needed for device draping, docking and undocking is approximately 3 min.

Funding

None.

Co-Authors

Łukasz Nowak, MD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Joanna Chorbińska, MD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Szymon Pisarski,
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Jan Łaszkiewicz,
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Wojciech Tomczak, MD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Bartosz Małkiewicz, MD, PHD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland

Tomasz Szydełko, Prof., MD, PHD
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland