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Analysis of performance factors in 240 consecutive cases of robot-assisted flexible ureteroscopic stone treatment

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Flexible ureteroscopy is the keystone of modern kidney stone treatment. Although a simple surgical technique achieves good clinical results and a low complication rate, there are high demands on the surgeon’s dexterity and ergonomic restrictions. Robotic-assisted flexible ureteroscopy (rfURS) could overcome these limitations. After 4 years of use of rfURS at a tertiary stone center, performance factors were analyzed to define the role of rfURS in kidney stone management. A rfURS system was installed in August 2014 at the SLK Kliniken (Heilbronn, Germany). Treatment data of N = 240 consecutive patients undergoing rfURS were prospectively collected and analyzed. The patient cohort represents typical stone formers. N = 240 renal units containing 443 stones with an average stone load of 1798 mm3 were treated. Surgical parameters as well as the peri- and postoperative complications were recorded, analyzed and compared to the current data in the literature. OR time 91 min, stone treatment time 55 min, stone treatment efficacy 33 mm3/min; perioperative complications 5.4%; robot times: preparation 5 min, docking 5 min, console time to stone contact 6 min, console time 75 min; postoperative complications 6.7%; postoperative length of stay 1.5 days; stone-free rate (residuals < 2 mm) 90% and re-treatment rate 8.75%. This consecutive series represents real-life data about the utilization of rfURS. The detailed analysis of performance factors revealed the successful utilization of the first generation of robotic systems in endourologic stone surgery, and indicates that the robot performs comparably to conventional flexible URS. Optimal ergonomics maintain the surgeon’s endurance in long-lasting surgeries.

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The robotic device was provided by ELMED, Turkey.

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Correspondence to Jan Klein.

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Ethical approval

All procedures being performed were part of the routine care. Ethical approval was obtained by the local Ethical commitee.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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No identifying information about patients is included in the article.

Conflict of interest

Jan Klein MD declares that he has no conflict of interest. Nikos Charalampogiannis MD declares that he has no conflict of interest. Marcel Fiedler MD declares that he has no conflict of interest. Gamal Wakileh MD declares that he has no conflict of interest. Ali Goezen MD declares that he has no conflict of interest. Jens Rassweiler MD declares that the Avicenna Roboflex system used in this study was provided by ELMED Medical Company (Ankara, Turkey).

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Klein, J., Charalampogiannis, N., Fiedler, M. et al. Analysis of performance factors in 240 consecutive cases of robot-assisted flexible ureteroscopic stone treatment. J Robotic Surg 15, 265–274 (2021).

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