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Flexible Robotic Ureterorenoscopy: Initial Experience: Monish Aron, Georges-Pascal Haber, Mihir M Desai, Troy R Gainduzzo and Inderbir S. Gill reported their initial experimental evaluation of a flexible robotic system (Hanseen Medical Mountain View Ca) for diagnostic and therapeutic ureterorenoscopy in five female swine.

This system is composed of a remote catheter manipulator (RCM), a workstation console, an electronics rack, a steerable scope (12F) and outer sheath (14F), which are in turn, controlled with a joystick by a surgeon at the console. 85/86 calyces were successfully inspected in 10 kidneys. The time required to inspect the collecting system was 49secs-15min. Both reproducibility (the ability to examine the calyx 3x) and stability (the ability to stay in position for 5 min) were rated 10/10 on a visual analogue scale while the auto-retract mechanism was rated at 8/10. All calculi inserted in these kidneys were successfully fragmented. Only one out of ten kidneys (10%) had a perforation after the procedure.

The authors should be commended for such an excellent work on their initial experience with robotic flexible ureteroscopy. This platform will undoubtedly serve as the take-off point for the future development of a fully flexible robotic system which could be applied either endoluminally or transabdominally through a single skin incision or through a natural orifice (NOTES). Potentially, it could make the rigid robotic platform a thing of the past.

Augmented Reality Visualization during Laparoscopic Urologic Surgery: The Initial Clinical Experience: Osamu Ukimura, Masahiko Nakamoto, Mihir M Desai, Brian Herts, Monish Aron, Georges-Pascal Haber, Jihad H Kaouk, Tsuneharu Miki, Yoshinobu Sato, Makoto Hashizume, Inderbir S Gill described their initial experience with the use of augmented reality for surgical navigation in laparoscopic urology. They employed this method in 25 laparoscopic cases: partial nephrectomy (9) radical nephrectomy (1) donor nephrectomy (1) radical prostatectomy (13) and radical cystectomy (1). Accurate and precise imaging could be superimposed on the actual intraoperative anatomy in the laparoscopic view, thus allowing real time surgical navigation and dissection, facilitating complete extirpative tumor excision with negative margins in cancer surgery as well as safe isolation of vascular structures in donor nephrectomy.


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