New Robotic Platform for Flexible Ureteroscopy: Development and Simulation based training (Atena Editora)

Abstract

Introduction: Indications for the treatment of kidney stones using flexible ureteroscopy have increased significantly in recent years, associated with the increase in the number of urologists trained to perform this procedure. However, this surgery is long and tiring for the surgeon, especially in more complex cases of renal lithiasis, leading to a loss in the surgeon's ergonomics.

Objectives: Therefore, a technological innovation was devised with the development of a prototype robotic system platform, to adapt to most commercially available flexible ureteroscopes and simulate the movements of human hands when manipulating flexible ureteroscopes, with greater ergonomics and comfort for the urologist and favoring the training of residents in urology.

Materials and Methods: The prototype consists of two elements: the flexible ureteroscope fixation platform and the surgeon's console. The robotic platform has mechanisms controlled by motors that perform the movements of the flexible ureteroscope: flexion and deflection, rotation and advancement in the renal pelvis. The console is portable and has a video monitor, controlling the movements of the ureteroscope using the joystick. The robotic platform was developed at a cost of less than $10,000. For surgical training with this new robotic platform, a synthetic human model will be used for simulation and training of residents on our team. The robotic simulation procedures will use a synthetic human model, where six residents underwent training in five simulated surgeries, with three 5 mm fragments of calcium carbonate, simulating kidney stones, being positioned in the upper, middle and lower calyces of the kidney.

Results: The simulated surgical procedure using the robotic platform was successful, being tested individually by six residents and after the third resident training session, a significant improvement was demonstrated in the simulation stages of the surgical procedure, with fragmentation of all calculations and reduction of procedure time.

Conclusions: The universal robotic platform for flexible ureteroscopic surgery was initially developed for training in kidney stone treatment. This mechanism is low cost when compared to similar robotic mechanisms already in use and can be used for the training of residents and urologists who are improving their skills in robotic flexible ureteroscopy surgeries, also providing good ergonomics for the surgeon.