Pd22-05 Robotic Percutaneous Nephrolithotomy (Pcnl): The Initial Clinical Experience

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-05 ROBOTIC PERCUTANEOUS NEPHROLITHOTOMY (PCNL): THE INITIAL CLINICAL EXPERIENCE Jaime Landman, Mihir Desai, Roshan M. Patel, Pengbo Jiang, Andrei D. Cumpanas, Nancy Sehgel, Jacob W. Caldwell, Chiara Gatti, William J. Petraiuolo, Paul T. Morris, and Ralph V. Clayman Jaime LandmanJaime Landman , Mihir DesaiMihir Desai , Roshan M. PatelRoshan M. Patel , Pengbo JiangPengbo Jiang , Andrei D. CumpanasAndrei D. Cumpanas , Nancy SehgelNancy Sehgel , Jacob W. CaldwellJacob W. Caldwell , Chiara GattiChiara Gatti , William J. PetraiuoloWilliam J. Petraiuolo , Paul T. MorrisPaul T. Morris , and Ralph V. ClaymanRalph V. Clayman View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe the first clinical experience of robotic-assisted mini-PCNL. This novel approach for PCNL combines robotic ureteroscopic visualization and lithotripsy, a robotic percutaneous flexible and steerable suction catheter for stone immobilization and fragment removal, electromagnetically (EM) guided percutaneous access, and an integrated aspiration and irrigation fluid management system. METHODS: Thirteen patients underwent robotic-assisted PCNL for renal calculi at University of California Irvine's Department of Urology, using the novel MONARCH™ Platform, Urology (Ethicon, Redwood City, CA). Procedures were performed in a modified supine position. Percutaneous access was gained under EM navigation, and an 18 Fr percutaneous sheath was placed to deploy a flexible 15 Fr steerable suction catheter. Stone visualization and ablation were performed ureteroscopically. Both the suction catheter and ureteroscope were robotically driven with a hand-held console that also controlled the irrigation and aspiration system. On post operative day (POD) 30, CT scans using 2-3 mm cuts were defined as absolute stone-free (Grade A), <2 mm remnants (Grade B), or 2.1-4 mm remnants (Grade C). RESULTS: Patients had a median age of 65 years (IQR:17) and a mean BMI of 26.9 kg/m2 (SD: 4.68). In 12/13 procedures the robot successfully completed PCNL, and in the final procedure robot failure at the end required manual completion. The pre-operative stone burden was quantified by both maximum linear measurements (32.8 mm+/-15.9 mm) as well as by CT-based volumes (1631.77+/-1121 mm3). Eight patients had pre-operative stones located in multiple calyces. Percutaneous access was gained directly through the papilla in a single pass in all cases. Stone fragments were removed through a single tract. Operative time was 187 minutes (83-383 minutes). All procedures were concluded without a nephrostomy tube and placement of an indwelling ureteral stent; 11 patients were discharged after an overnight stay. On POD 30, significant stone burden reduction (73% to 100%) was observed, with five patients completely stone-free (Grade A, 35.71%), one Grade B (7.10%), and two Grade C (14.20%). Two patients presented with grade 1 (1 UTI and 1 PULS 2 ureteral wall injury), and 1 patient presented with a grade 2 Clavien Dindo surgical complication. There were no robotic device-related adverse events. CONCLUSIONS: We report the world's first-in-human study of robotic-assisted mini-PCNL demonstrated the safety, efficacy, and feasibility of robotic—assisted PCNL across a wide range of clinical stone burden scenarios. Source of Funding: This clinical trial was sponsored by Johnson & Johnson © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e462 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jaime Landman More articles by this author Mihir Desai More articles by this author Roshan M. Patel More articles by this author Pengbo Jiang More articles by this author Andrei D. Cumpanas More articles by this author Nancy Sehgel More articles by this author Jacob W. Caldwell More articles by this author Chiara Gatti More articles by this author William J. Petraiuolo More articles by this author Paul T. Morris More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...