title: A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b).
abstract: BACKGROUND
  An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique.
  
  
  OBJECTIVE
  To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework.
  
  
  METHODS
  Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2).
  
  
  METHODS
  Robotic FURS was performed with the Roboflex Avicenna robotic device.
  
  
  METHODS
  Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant.
  
  
  CONCLUSIONS
  Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished.
  
  
  CONCLUSIONS
  Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS.
  
  
  RESULTS
  Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics.
authors: Department of Urology, Medicana International Hospital, Ankara, Turkey.
authors: Remzi
authors: R
authors: Saglam
authors: Department of Urology, Bagcilar Training Hospital, Istanbul, Turkey.
authors: Ahmet Yaser
authors: AY
authors: Muslumanoglu
authors: Department of Urology, Medicana International Hospital, Ankara, Turkey.
authors: Zafer
authors: Z
authors: Tokatlı
authors: Department of Urology, Medeniyet University Hospital, Istanbul, Turkey.
authors: Turhan
authors: T
authors: Caşkurlu
authors: Department of Urology, Kartal Training Hospital, Istanbul, Turkey.
authors: Kemal
authors: K
authors: Sarica
authors: Department of Urology, Bakırköy Training Hospital, Istanbul, Turkey.
authors: Ali İhsan
authors: Aİ
authors: Taşçi
authors: Department of Urology, Medipol University Medical School Hospital, Istanbul, Turkey.
authors: Bülent
authors: B
authors: Erkurt
authors: Department of Urology, Ankara University Medical School Hospital, Ankara, Turkey.
authors: Evren
authors: E
authors: Süer
authors: Department of Bioengineering, Hacettepe University, Ankara, Turkey.
authors: Ahmet Sinan
authors: AS
authors: Kabakci
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Glenn
authors: G
authors: Preminger
authors: Department of Urology, Université Pierre et Marie Curie, Hôpital Tenon, Paris, France.
authors: Olivier
authors: O
authors: Traxer
authors: Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany; Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: jens.rassweiler@slk-kliniken.de.
authors: Jens J
authors: JJ
authors: Rassweiler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002648:Child; D004867:Equipment Design; D006804:Ergonomics; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000295:instrumentation*; D055815:Young Adult
keywords: Ergonomics; Retrograde intrarenal surgery; Robotics; Surgical manipulator; Telesurgery; Ureterorenoscopy; Urolithiasis