Impact of Renal Access Angle and Speed of Nephroscope Retrieval Movements on the Vortex Effect.

Autor: Ito WE; Department of Urology, The University of Kansas Health System, Kansas City, KS., Prokop DJ; The University of Kansas School of Medicine, Kansas City, KS., Whiles BB; Department of Urology, The University of Kansas Health System, Kansas City, KS., Sardiu ME; Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS., Smith H; Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS., Neff DA; Department of Urology, The University of Kansas Health System, Kansas City, KS., Duchene DA; Department of Urology, The University of Kansas Health System, Kansas City, KS., Molina WR; Department of Urology, The University of Kansas Health System, Kansas City, KS. Electronic address: wmolina@kumc.edu.
Jazyk: angličtina
Zdroj: Urology [Urology] 2024 Jan; Vol. 183, pp. 50-56. Date of Electronic Publication: 2023 Nov 10.
DOI: 10.1016/j.urology.2023.10.030
Abstrakt: Objective: To analyze the influence of different renal access angles (AAs) and nephroscope retrieval speeds on the efficacy of the vortex effect (VE) in mini-percutaneous nephrolithotomy (mini-PCNL). This study aimed to understand the poorly understood physical components of the VE.
Materials and Methods: A Pexiglas™ (KUS®) model was built based on the dimensions of a 15/16 F mini-PCNL set (Karl Storz). The flow rate was continuous via an automatic pump and calibrated to achieve hydrodynamic equivalence to the real equipment. One experiment consisted of manually retrieving all 30 stone phantoms (3 mm diameter) utilizing only the VE. Cumulative time to retrieve all stones was measured. An accelerometer recorded instant speeds of the nephroscope every 0.08 seconds (s), and 3 experiments were performed at each angle (0°, 45°, and 90°). A logistic regression model was built utilizing maximum speeds and access angles to predict the effectiveness of the VE.
Results: Mean cumulative time for complete stone retrieval was 28.1 seconds at 0° vs 116.5 seconds at 45° vs 101.4 seconds at 90° (P < .01). We noted significantly higher speeds at 0° compared to 45° and 90° (P < .01); however, differences in average and maximum speed between 45° and 90° were not statistically significant (P = .21 and P = .25, respectively). The regression model demonstrated a negative association between increasing maximum speed and VE's effectiveness (OR 0.547, CI 95% 0.350-0.855, P < .01). When controlling for maximum speed, the 0° angle had significantly higher chances of achieving at least a partially effective VE.
Conclusion: Increasing the renal access angle or nephroscope extraction speed negatively impacts the effectiveness of the VE. This significantly increased procedure time in the laboratory model, suggesting that the VE is less effective at higher sheath angles.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Wilson Rica Molina reports a relationship with Olympus Surgical Technologies America that includes: consulting or advisory, funding grants, and speaking and lecture fees. Wilson Rica Molina reports a relationship with Boston Scientific Corp that includes: consulting or advisory, funding grants, and speaking and lecture fees. Wilson Rica Molina reports a relationship with Fortec that includes: consulting or advisory, funding grants, and speaking and lecture fees. Wilson Rica Molina reports a relationship with IPG that includes: consulting or advisory, funding grants, and speaking and lecture fees. Donald Neff reports a relationship with Boston Scientific Corp that includes: consulting or advisory, funding grants, and speaking and lecture fees. David Duchene reports a relationship with Lumenis Inc Americas that includes: consulting or advisory, funding grants, and speaking and lecture fees. All other authors have no disclosures to inform.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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