Verification of surgical factors affecting the efficiency of stone extraction using a f-URSL simulation model

Abstract

Abstract When performing flexible ureteroscopic lithotripsy for upper urinary stones, an important treatment option is stone extraction. In this study, we aim to investigate the surgical factors affecting the efficiency of stone extraction and surgeon stress using a flexible ureteroscopic lithotripsy simulator model. This simulator-based study involved 16 participants: eight urologists and eight residents. Participants each performed two tasks eight times, with two types of ureteral access sheath (Flexor or Navigator), with or without M-arm, and with left or right kidney models. Task1 was to touch each renal calix with the ureteroscope, and Task2 was to extract stones. The recorded outcomes of this study were the number of times that the ureteroscope got stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. The number of times that the ureteroscope got stuck was significantly higher when Navigator was used compared with Flexor overall, and for urologists and residents (all P < 0.01). The number of times a stone was dropped was significantly higher in the ipsilateral group than in the contralateral group overall (P = 0.01), and the number of times the basket forceps were opened and closed was significantly higher in the ipsilateral group than in the contralateral group both overall and for residents (all P < 0.01). Differences in ureteral access sheath and the kidney side were surgical factors affecting the efficiency of stone extraction during flexible ureteroscopic lithotripsy with the one-surgeon basketing technique.