Pd47-06 Impact of Integrated, Real-Time Digital Measurement on Surgeon Decision Making in Ureteroscopic Stone Surgery

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) IV (PD47)1 May 2024PD47-06 IMPACT OF INTEGRATED, REAL-TIME DIGITAL MEASUREMENT ON SURGEON DECISION MAKING IN URETEROSCOPIC STONE SURGERY Alexander Krueger, Drew M. Smith, Andrew T. Parzych, Robert Qi, Aaron M. Potretzke, Dan Stoianovici, David Holmes, Mark Lifson, and Kevin Koo Alexander KruegerAlexander Krueger , Drew M. SmithDrew M. Smith , Andrew T. ParzychAndrew T. Parzych , Robert QiRobert Qi , Aaron M. PotretzkeAaron M. Potretzke , Dan StoianoviciDan Stoianovici , David HolmesDavid Holmes , Mark LifsonMark Lifson , and Kevin KooKevin Koo View All Author Informationhttps://doi.org/10.1097/01.JU.0001008652.62443.0a.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate estimation of stone fragment size during ureteroscopic lithotripsy facilitates decisions to extract fragments or leave them behind for spontaneous passage. A novel software capable of accurately measuring these fragments in real-time during ureteroscopy has been developed, but the impact on surgeons' decision-making is not known. The aim of this study is to assess the clinical use of this software and its impact on intraoperative decision-making. METHODS: Adult patients undergoing elective flexible ureteroscopy and laser lithotripsy for renal stones were prospectively enrolled. Surgeons could request digital measurement of stones or fragments at any time during the procedure. All measurements were reported to the surgeon in real-time. Surgeons were surveyed after each case about the reasons for taking measurements and how the measurements impacted their intraoperative decisions. 30-day clinical complications were recorded. RESULTS: Among a total of 51 patients undergoing ureteroscopy, surgeons took an average of 2.1 (range 1-6) intraoperative measurements per case. The software was deployed successfully in all cases. Surgeons reported that the primary purpose of taking intraoperative measurements was to determine whether post-lithotripsy fragments were extractable (26, 51.0%) or sufficiently small to leave behind (5, 9.8%). However, surgeons also took measurements prior to lithotripsy to confirm extractability (23, 45.1%), or to assess overall stone size (4, 9%). Following stone measurements, surgeons changed intraoperative plans in 17 (33%) cases and instead continued lithotripsy (8, 15.7%), extracted fragments (7,13%), or left fragments behind for passage (2, 3.9%) (Figure 1). Surgeons rated the ability to take intraoperative measurements as "very helpful" (66%) or "somewhat helpful" (34%). In no cases (0%) were measurements "not helpful." The time burden of taking affected procedural efficiency in only 4% of cases. There was 1 sepsis complication among the cases (2%). CONCLUSIONS: The ability to take real-time stone measurements during flexible ureteroscopy changed surgeons' intraoperative decisions in 33% of cases. This may improve procedural efficiency and reduce fragment extraction failures and ureteral injury. Download PPT Source of Funding: Endourological Society © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e982 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Krueger More articles by this author Drew M. Smith More articles by this author Andrew T. Parzych More articles by this author Robert Qi More articles by this author Aaron M. Potretzke More articles by this author Dan Stoianovici More articles by this author David Holmes More articles by this author Mark Lifson More articles by this author Kevin Koo More articles by this author Expand All Advertisement PDF downloadLoading ...