An irrigation system for noninvasively estimating intrarenal pressure during flexible ureteroscopy

Abstract

Background: High intrarenal pressure (IRP) during flexible ureteroscopy (FURS) may lead to severe complications. Reported methods for measuring IRP are often inconvenient to use, expensive and involve instruments that occupy the narrow ureter. Methods:We proposed an irrigation system, which can noninvasively estimate IRP based on the principle of fluid mechanics. To determine the feasibility of our system, we conducted irrigation experiments on a kidney phantom and a porcine kidney.The estimated IRPs were compared with the ground truth IRPs.Results: When no surgical instrument was inserted into the flexible ureteroscope's working channel, our system can estimate IRP with high accuracy. When a surgical instrument was inserted, our system can approximately estimate the level of IRP.Conclusions: Our proposed irrigation system can noninvasively estimate IRP, presenting a new thought for clinical practice. In future studies, in vivo experiments are needed to further validate and improve the system.

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

“…The actuator consists of two friction wheels that are compressed by springs and can adapt to instruments with various outer diameters. Furthermore, an automatic irrigation module that can noninvasively estimate the intrarenal pressure 22 is integrated into the top of the slave robot.…”

“…Furthermore, an automatic irrigation module that can noninvasively estimate the intrarenal pressure 22 is integrated into the top of the slave robot.…”

Retrograde intra renal surgery and safety: pressure and temperature. A systematic review

“…Seven fully in vitro studies were published in the past two years, three using cadaveric pigs kidney model and two with living animal models (pigs) (Table 1). Various methods of IRP measurement were used: antegradely through percutaneous access [13,17–19], retrogradely aside from the scope [16,20,21,22 ▪▪ ] or through the fURS working channel [23,24] and using a robotic system [25]. Among this studies, IRP is decreased with a reduced inflow (occupied working channel) and an increased outflow (UAS insertion), except in Doizi et al study where a 10–12Fr UAS with 193 cmH 2 O was not associated with an IRP decrease [13,18,22 ▪▪ ,25].…”

“…Various methods of IRP measurement were used: antegradely through percutaneous access [13,17–19], retrogradely aside from the scope [16,20,21,22 ▪▪ ] or through the fURS working channel [23,24] and using a robotic system [25]. Among this studies, IRP is decreased with a reduced inflow (occupied working channel) and an increased outflow (UAS insertion), except in Doizi et al study where a 10–12Fr UAS with 193 cmH 2 O was not associated with an IRP decrease [13,18,22 ▪▪ ,25]. In their experiment on an in vitro renal model, IRPs during fURS ranged in vitro from 1.4 to 46.2 cmH 2 O [22 ▪▪ ].…”

“…75, and 150 mmHg, respectively [26]. As a solution to IRP increase during fURS, several devices are under evaluation: new UAS and robotic system [24,25,27]. A syphon 11/13Fr UAS has been proposed to increase inflow but with lower IRP.…”