Evaluating the Automated Thermedx Fluid Management System in a Ureteroscopy Model

De, Shubha; Torricelli, Fábio César Miranda; Sarkissian, Carl; Kartha, Ganesh; Monga, Manoj

doi:10.1089/end.2013.0697

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…What ‘harm’ or ‘undesired outcomes’ other than infection may result from elevated renal pelvis pressures, such as potential worse postoperative pain or colic? It is our hope that with continued advancements in technology in this field, including the ability to measure intra‐luminal pressure in real‐time [ 12 ], as well as the development of electronic automated fluid management systems to control irrigation fluid pressures [ 13 ] that research as how management of renal pelvis pressure during URS can improve outcomes is a continued area of study. While it is possible with current technologies to measure renal pelvis pressure in real‐time during URS (as has previously been published) [ 11 , 14 ], currently the use of equipment to do this type of real‐time monitoring is prohibitive either from a cost or a workflow perspective.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model

et al. 2022

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Objective To evaluate the relationship between renal pelvis pressure and fluid absorption during ureteroscopy (URS) in a live porcine model. Materials and Methods Flexible URS (fURS) was performed in anaesthetised female Yorkshire pigs. Prior to performing fURS, a 0.3556‐mm (0.014″) pressure‐sensing guidewire (Comet™, Boston Scientific) was placed to monitor renal pelvis pressure. A simulated fURS procedure was then performed for 1 h. Infusion of irrigation fluid (5% ethanol in saline) at target renal pelvis pressures (37–150 mmHg) was maintained for 1 h using a pressure bag and real‐time feedback from the pressure‐sensing guidewire. Venous blood was sampled every 10 min. The volume of irrigation fluid absorbed was estimated with established equations. Results A URS procedure was performed in vivo in 18 porcine kidneys and the volume of irrigation fluid absorbed during the 1 h URS was calculated. The mean (SD) volume of irrigation fluid absorbed after 1 h of simulated URS was 7.6 (5.7), 10.8 (7.1), 26.0 (15.8), and 56.8 (22.3) mL at renal pelvis pressures of 37, 55, 75, and 150 mmHg, respectively. Compared with URS with renal pelvis pressure of 37 mmHg, the volume of fluid absorption was significantly greater at renal pelvis pressures of 75 and 150 mmHg (P = 0.026 and P = 0.047, respectively). In addition, compared with URS with renal pelvis pressure of 37 mmHg, the rate of absorption was significantly greater at renal pelvis pressures of 75 and 150 mmHg (both P < 0.001). Conclusion In this study of an in vivo porcine model of URS, increasing renal pelvis pressures during URS were associated with increases in irrigation fluid absorption and increases in the rate of fluid absorption.

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Section: Discussionmentioning

confidence: 99%

Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model

et al. 2022

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“…Both the TFS and CRF are automated irrigation systems with pressure and temperature control for the purpose of providing steady irrigation during ureteroscopy. In our previous study evaluating only the Thermedx system, we found that the TFS monitoring system underestimated pressures and overestimated both flow rates and temperatures delivered through the endoscope (3). In this study, we retested both the TFS with the addition of the CRF system, with a focus on pressure accuracy.…”

Section: Discussionmentioning

confidence: 97%

“…A previous in vitro analysis of the TFS system was performed at our institution using a rigid ureteroscopy model to characterize the rate of temperature change, pressure accuracy, and the precision of the continuous pressure monitoring (3). This analysis demonstrated that the TFS sys-tem overestimated the temperature and flow rate while underestimating the pressure supplied, however, these discrepancies were not significant enough to limit functionality or safety (3). As far as we are aware, no similar in vitro or in vivo comparisons using the Thermedx FluidSmart® or the Cogentix RocaFlow® have been conducted since this publication.…”

Section: Introductionmentioning

confidence: 99%

Comparison of automated irrigation systems using an in vitro ureteroscopy model

2020

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Introduction: Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-fl ow relationships, and fl uid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system. Materials and Methods: An in vitro ureteroscopy model was used for testing, consisting of a short semirigid ureteroscope (6/7, 5F, 31cm Wolf 425612) connected to a continuous digital pressure transducer (Meriam m1550). Each system pressure output and fl ow-rate, via 100mL beaker fi lling time, was measured using multiple trials at pressure settings between 30 and 300mmHg. Output fl uid temperature was monitored using a digital thermometer (Omega DP25-TH). Results: The pressure output of both systems exceeded the desired setting across the entire tested range, a difference of 15.7±2.4mmHg for the TFS compared to 5.2±1.5mmHg for the CRF (p <0.0001). Related to this fi nding, the TFS also had slightly higher fl ow rates across all trials (7±2mL/min). Temperature testing revealed a similar maximum temperature of 34.0⁰C with both systems, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test, while the CRF took over 18 minutes to reach a similar peak. Conclusions: Our in vitro ureteroscopy testing found that the CRF system had better pressure accuracy than the TFS system but with noticeably slower fl uid heating capabilities. Each system provided steady irrigation at safe pressures within their expected operating parameters with small differences in performance that should not limit their ability to provide steady irrigation at safe pressures.

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“…The Thermedx pump exhibits accurate flow, pressure, and temperature data. 7 Maximum infusion pressure with this AIP is 300 mm Hg.…”

Section: Irrigation Equipmentmentioning

confidence: 96%

“…Prior studies have characterized the performance of a variety of manual [3][4][5] and automated 2,[6][7][8] endoscopic irrigation systems used in endourology, but have failed to examine the labor and operating room (OR) efficiency associated with these different irrigation systems. The potential for enhanced OR efficiency is notable, given that OR procedures account for an estimated 40% of hospital costs and generate over 60% of hospital revenue.…”

Section: Introductionmentioning

confidence: 99%

Prospective Randomized Comparison of Standard Hand Pump Infuser Irrigation vs an Automated Irrigation Pump During Percutaneous Nephrolithotomy and Ureteroscopy: Assessment of Operating Room Efficiency and Surgeon Satisfaction

Jefferson

Sung

Limfueco

et al. 2020

Journal of Endourology

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Introduction:The objective of this study was to determine if use of an automated irrigation pump (AIP) during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) affects circulating nurse labor, irrigationrelated issues, and surgeon and nurse satisfaction when compared to manual hand pump (HP) irrigation. Methods: Eighty consecutive adult patients undergoing unilateral URS or PCNL were prospectively randomized to irrigation with the HP or AIP. Preoperative pump setup time, intraoperative pump maintenance time, total pump time (setup+maintenance), and the number of irrigation-related concerns verbalized by the surgeon intraoperatively were recorded; postoperatively, surgeons and nurses rated their satisfaction with the irrigation system (1 = highly dissatisfied to 10 = highly satisfied). Results: Eighty patients were enrolled (39 AIP and 41 HP); 51 patients underwent URS and 29 patients underwent PCNL. On univariate analysis, the AIP resulted in a significantly reduced total pump time for URS (2.9 vs 5.9 minutes) and PCNL (4.6 vs 33.9 minutes; p < 0.001). The number of irrigation-related concerns was significantly lower in the AIP group during URS (1.2 vs 2.8, p < 0.001), but not during PCNL (1.9 vs 4.0, p = 0.07). The AIP was associated with significantly higher nurse satisfaction during URS (9.2/10 vs 6.5/10, p < 0.001) and PCNL (9.4/10 vs 4.4/10, p = 0.001). There was no significant association between pump type and surgeon satisfaction. On multivariate analysis of URS cases controlling for body mass index and number of stones, use of the AIP was a predictor of total pump time <5 minutes (odds ratio 25.8, 95% confidence interval [CI] 4.0-165.4; p < 0.001) and favorable (8-10/10) nurse satisfaction rating (odds ratio 25.4, 95% CI 4.1-164.0; p < 0.001). Operative time, stone-free rate, and liters of irrigant used with the HP and AIP were similar. Conclusions: During URS and PCNL, the AIP was associated with a significant reduction in irrigation pump time and higher nurse satisfaction.

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Evaluating the Automated Thermedx Fluid Management System in a Ureteroscopy Model

Abstract: The TFMS provides a pressurized/warmed irrigation strategy for many endoscopic procedures. It is important to note that the system underestimates pressures at the tip of the endoscope, while overestimating the flow rates and temperatures delivered from the scope when utilizing the device.

Cited by 13 publications

References 10 publications

Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model

Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model

Comparison of automated irrigation systems using an in vitro ureteroscopy model

Prospective Randomized Comparison of Standard Hand Pump Infuser Irrigation vs an Automated Irrigation Pump During Percutaneous Nephrolithotomy and Ureteroscopy: Assessment of Operating Room Efficiency and Surgeon Satisfaction

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