Presented by: Andrei Cumpanas MD
Department of Urology, University of California, Irvine; Orange, CA, USA

Introduction

We describe the initial clinical experience with a novel PCNL approach that combines electromagnetic (EM) targeting, robotic URS lithotripsy, a robotic percutaneous catheter for stone immobilization and fragment removal and an integrated irrigation and suction fluid management system.

Materials

Four patients underwent robotic PCNL and URS lithotripsy of their kidney calculi at University of California Irvine’s Department of Urology, using the novel MONARCH™ Platform (Ethicon, Redwood City, CA) (Figure 1-A). Procedures were performed in a modified supine position. Percutaneous access was gained using a novel EM targeting system (Figure 1-B). An 18 Fr percutaneous sheath was placed for deployment of a flexible 15 Fr steerable suction catheter. Stone visualization and ablation was performed ureteroscopically.  Both the suction catheter and ureteroscope were robotically driven via a hand-held robotic controller that also controlled a third-party laser fiber, robotic basket, as well as the irrigation and aspiration system (Figure 1-C).

Results

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To date, all robotic procedures have been technically successful, without any device- or surgically related complications. With a preoperative stone burden ranging from 10.5 mm to 24.6 mm (CT-segmentation-derived volumes: 1411.44 mm³ - 2067.21 mm³), the combined robotic PCNL and URS lithotripsy were associated with a reduction in stone burden volume ranging from 81% to 100% as assessed by thin slice CT imaging performed within 30 days of the surgery (Figure 2). Blood loss ranged from 25 mL to 150 mL. The operative time ranged from 129-388 min.

Conclusion

Early robotic mini-PCNL clinical experience shows technical feasibility, early promise of the integrated fluid management system and novel EM targeting system. This robotic PCNL platform allows for the completion of the entire procedure and control of all retrograde and antegrade instruments by a single urologist.

Funding

Sponsor: Auris Health, Inc.

Co-Authors

Mihir M. Desai, MD
Department of Urology, University of Southern California

Nancy L. Sehgel, PhD
Ethicon Research & Development

Jacob W. Caldwell, MS
Ethicon Research & Development

Chiara Gatti, MS
Ethicon Research & Development

Andrei D. Cumpanas, MD
Department of Urology, University of California Irvine

Pengbo Jiang, MD
Department of Urology, University of California Irvine

Roshan M. Patel, MD
Department of Urology, University of California Irvine

Ralph V. Clayman, MD
Department of Urology, University of California Irvine

Jaime Landman, MD
Department of Urology, University of California Irvine