Comparison of New Single-Use Digital Flexible Ureteroscope Versus Nondisposable Fiber Optic and Digital Ureteroscope in a Cadaveric Model

Abstract

Purpose: To evaluate LithoVue, the new single-use digital flexible ureteroscope, in a human cadaveric model and compare it with a nondisposable fiber optic and digital flexible ureteroscopes.Materials and Methods: LithoVue, a conventional fiber optic, and digital flexible ureteroscopes were each tested in four renal units of recently deceased female cadavers by three surgeons. The following parameters were analyzed: accessibility to the kidney and navigation of the entire collecting system with and without ureteral access sheath (UAS), lower pole access measuring the deflection of the ureteroscope with the working channel empty, and with inside two different baskets and laser fibers. A subjective evaluation of maneuverability and visibility was assessed by each surgeon at the end of every procedure.Results: Kidney access into the Renal unit 1 was not possible without UAS for all ureteroscopes because of noncompliant ureter at the level of sacroiliac joint. The reusable digital ureteroscope was unable to reach one calix of the lower pole and one calix of the upper pole (Renal units 2 and 3) without UAS placement. Lower pole access with baskets and laser fibers was possible for each ureteroscope after UAS placement. No statistically significant differences were detected in angle deflection between ureteroscopes. The digital ureteroscope was preferred for visibility in all procedures: LithoVue for maneuverability in six procedures, fiber optic in five procedures, and the digital ureteroscope in one procedure.Conclusions: LithoVue seems to be comparable with conventional ureteroscopes in terms of visibility and manipulation into the collecting system in fresh human cadavers. Further studies in humans are needed to determine the clinical value of this new instrument.

A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

“…Its use may mitigate the costs and burdens associated with the use of reusable flexible ureteroscopes. Preliminary work evaluating LithoVue has involved cadaveric, 6 in vitro, 7 in vivo, 8 and ex vivo porcine model studies, 9 as well as case reports 10 and one clinical feasibility study. 11 These studies revealed that LithoVue is comparable with existing conventional, reusable flexible ureteroscopes in terms of visual image quality, intraoperative maneuverability, and user satisfaction.…”

Fiberoptic versus Digital: A Comparison of Durability and Cost Effectiveness of the Two Flexible Ureteroscopes

“…Ever since, flexible ureteroscopy has been in use increasingly for therapeutic interventions. Indeed, the development of small caliber flexible ureteroscopes with sufficient working channel, use of higher-up quality materials in working elements, and the advanced active and passive deflection abilities have accelerated the widespread adoption of the procedure even in the more complex cases [13,14]. Recently, flexible digital ureteroscopes having built-in digital camera and light source have been developed and released for better image quality.…”

“…Recently, flexible digital ureteroscopes having built-in digital camera and light source have been developed and released for better image quality. Although the digital ureteroscopes have better image quality, both fiberoptic and digital ureteroscopes can be used efficiently with comparable results [14]. Moreover, digital ureteroscopes have relatively larger distal tips around of 7.7-8.7F that may restrict access to upper urinary tract.…”

“…The miniaturization of current flexible ureteroscopes has undoubtedly improved the feasibility and effectiveness, but it makes them more vulnerable and fragile. The other important issue about the current flexible ureterescopes is higher cost [14]. As might be expected, the more improved technology brings with it much more expenditure.…”

URS Konusunda Teknolojik Gelişmeler

“…Bu cihaz her iki yönde de 270 derece defleksiyon yapma özelliğine sahiptir. Yapılan taze kadavra çalışmasında LithoVue'nun, diğer konvansiyonel fiberoptik ve dijital fleksibl üreterorenoskoplarla karşılaştırıldığında görüntü kalitesi ve manevra kabiliyetleri bakımından diğer-leri ile karşılaştırılabilir olduğu tespit edilmiştir (24). Daha sonra yapılan klinik çalışmalarda da hem LithoVue'nun maliyet bakımından daha ucuz olduğu tespit edilmiş hem de etkili olduğu ortaya konulmuştur (25,26).…”