Presented by: Vineet Gauhar MCh
Ng Teng Fong General Hospital

Introduction

Suction,asers and technology are changing the landscape in modern endourology. Efforts are focussed in improving single stage stone free rate(SFR),minimising re-intervention and reducing septic complications and improving PROMs in Retrograde intrarenal surgery(RIRS).Primary aim was to evaluate the ease, manoeuvrability and intraoperative visibility using a new Flexible and navigable suction acess sheath(FANS) during lithotripsy and its ability to extract fragments. Secondary outcomes were to assess SFR, short term complications (i.e. up to 3 months), to report mechanical failures, scope and sheath damage

Materials

Anonymized retrospective clnical audit of data on (AINU12/2022) RIRS performed in adults using 2 sizes of (12fr and 10fr) FANS called the ELEPHANT sheath from Yingbao company made in China, in two centres between Nov 2021 and Oct 2022 was perfomed. Inclusion criteria were adult with renal stones Complications evaluated within 30 days from RIRS up to 3 months. SFR was absence of single RF >2 mm on CT. Steps involved i) lithotomy ii)  cystoscopy iii) semirigid ureteroscopy iv) insertion of FANS  under fluoroscopy; v) deploying a dsisposable scope 8 Fr in a 12 Fr sheath (Group1) and 7.5 Fr for 10 Fr (Group2).Irrigation using the attached TRAXERFLOW was used to improve the flow in view of simultyaneous suction and aspiration intraoperatively.

Results

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Table 1 and 2 show outcomes.16 patients in Group 1 and 15 in Group 2

Overall,the 10 Fr FANS fared superiorly to 12 Fr sheaths .Both shaths were deflecatble even when the infundibulum-pelvic angle was acute with sligt advantage for the 10fr in the Lower pole.18 of 31 patients observed overnight with a ureteric catheter instead of a double j. All patients discharged within 24 hours with no readmission, Apart from a transcinet fever in some patients traetaed with overnight antibiotics there were no cases of sepsis. At 3-month, SFR was significantly higher in Group 2 (94.7% vs 68.8%, p=0.01). No patient had RF larger than 4 mm. No infectious complications seen

Conclusion

After a learning curve of 3-4 cases that require urologists to skillfully handle the scope and sheath simultaneously under fluroscopy guidance whilst navigating the anatomy and aspirating dust and fragments, it appears that RIRS with FANS is replicable, safe, achieves a high single stage SFR. Using a disposable scope allows for maximising the torque needed to actively and passively deflect the scope and sheath in the PCS. The 7.5Fr scope and 10fr sheath combination is marginally better in this.Suction has a dual advantage of aspirating and mainataing a low intrarenal pressure and avoids overdistention of the system. If on table inspection confirms no RF, using this sheath can potentially minimise need for stents, accessories and re-interventions which can be a cost saving option.

Funding

NIL

Lead Authors

Daniele Castellani, MD
Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona

Co-Authors

Olivier Traxer, MD
Sorbonne University, Department of Urology Hôpital Tenon,

Ben Chew, MD
University of British Columbia

Deepak Ragoori, MCh
Asian Institute of NephroUrology(AINU)

JeremyYuen-Chun Teoh, MD
S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong

Saeed Bin Hamri, MD
Advanced Laser Endourology at king Abdulaziz National Guard Medical City

Bhaskar Somani, MD
university hospital NHS trust,