The usefulness and ergonomics of a new robotic system for flexible ureteroscopy and laser lithotripsy for treating renal stones

Purpose: To investigate the usefulness and ergonomics of a newly developed robotic system for flexible ureteroscopy (easyUretero). Materials and Methods: During in vitro testing, six participants performed renal stone removal four times in an artificial kidney -ureter-bladder model. Each participant manipulated a single-use digital flexible ureteroscope (LithoVue) with their hands and the robotic system, sequentially. We compared the task completion times of each participant. The ergonomics of and operational satisfaction with each procedure were assessed by questionnaires. In vivo tests evaluated the operability and safety of the robotic system in two live female pigs. We checked that all the steps of flexible lithotomy for renal stones could be completed individually.Results: The task completion time with the robotic system during in vitro testing was significantly longer than with manual ure-teroscopy regardless of the operator's competence level (expert professors: 282.6 +/- 92.4 seconds vs. 73.6 +/- 43.3 seconds, p<0.001; fellows: 247.5 +/- 57.7 seconds vs. 95.8 +/- 43.7 seconds, p<0.001; residents: 281.3 +/- 111.0 seconds vs. 188.6 +/- 138.6 seconds, p<0.001). The residents took more time to remove the upper and mid caliceal stones with the robotic system. The ergonomic evaluation was better for the robotic system, but operational satisfaction was lower, and there was no statistical difference among the groups. In vivo tests showed that all the steps of robotic flexible ureteroscopy could be completed without difficulty. No safety issues were encountered during the procedure.