Robotically assisted ureteroscopy for kidney exploration

Abstract

Ureteroscopy is a minimally invasive procedure for diagnosis and treatment of a wide range of urinary tract pathologies. It is most commonly performed in the diagnostic work-up of hematuria and the diagnosis and treatment of upper urinary tract malignancies and calculi. Ergonomic and visualization challenges as well as radiation exposure are limitations to conventional ureteroscopy. For example, for diagnostic tumor inspection, the urologist has to maneuver the ureteroscope through each of the 6 to 12 calyces in the kidney under fluoroscopy to ensure complete surveillance. Therefore, we have been developing a robotic system to “power drive” a flexible fiber-optic ureteroscope with 3D tip tracking and pre-operative image overlay. Our goal is to provide the urologist precise control of the ureteroscope tip with less radiation exposure. Our prototype system allows control of the three degrees of freedom of the ureteroscope via brushless motors and a joystick interface. The robot provides a steady platform for controlling the ureteroscope. Furthermore, the robot design facilitates a quick “snap-in” of the ureteroscope, thus allowing the ureteroscope to be mounted midway through the procedure. We have completed the mechanical system and the controlling software and begun evaluation using a kidney phantom. We put MRI-compatible fiducials on the phantom and obtained MR images. We registered these images with the robot using an electromagnetic tracking system and paired-point registration. The system is described and initial evaluation results are given in this paper.

Robot-assisted flexible ureterorenoscopy: state of the art in 2022

“…The first clinical application of a master-slave controlled robotic system (Sensai-Magellan) for fURS was introduced by Desai and colleagues in 2008 [21] . Again, this system was modified from a cardiovascular intervention robot named Sensai [22] . In 2010, the development of a robot for fURS was started by Saglam and a Turkish company named ELMED (Ankara, Turkey).…”

Updates in endourological management of urolithiasis

“…With the advancement of robotic technology, a passive remote robotic catheter manipulator of an optical fiberscope was described by Desai in 2008 with a potential advantage of increased range of motion, instrument stability and improved ergonomics . Newer models have been developed, which support the concept of “add‐on module” using the commercially available fURS to attach onto the robot system . Initial results showed that the robot‐assisted system provides similar outcomes and is better ergonomically with the conventional fURS .…”

“…141 Newer models have been developed, which support the concept of "add-on module" using the commercially available fURS to attach onto the robot system. 142,143 Initial results showed that the robot-assisted system provides similar outcomes and is better ergonomically with the conventional fURS. 144 The role of robot-assisted fURS requires further evaluation from clinical studies.…”

“…For lower pole stones, the fURS needs to have near maximum flexion and rotation to reach the lower pole stones, which might lead to fatigue, and subsequent arm tremors and loss of long-term productivity for the urologist as a result chronic motion injury. 143 Repositioning the lower pole stone to a more convenient location (e.g. the upper pole or the renal pelvis) will help to improve the efficient and ergonomic position.…”

A novel robotic system for flexible ureteroscopy

“…For example, Desai and colleagues 21,22 developed a master‐slave controlled robotic system for fURS, which was modified from a cardiovascular intervention robot named Sensei 23 . Talari and colleagues 24 designed a robot with three degrees of freedom (DOFs) to manipulate a commercial flexible ureteroscope. Moreover, Saglam and colleagues 25–28 designed a robotic system especially for fURS, named Avicenna Roboflex (ELMED).…”