Next-generation ureteroscopes promise to improve surgical efficiency, outcomes

The landscape of ureteroscope options is constantly changing. This evolving technology not only offers more precision for urologists, but also better outcomes for patients. Saturday’s Plenary: “State-of-the-Art Lecture: Single-Use Ureteroscopes and New Technology: What Is in Store?” will highlight next-generation ureteroscopes and how they may improve your practice and patient care.

One new ureteroscope currently seeking Food and Drug Administration approval uses robotic technology and an intuitive video-game-like joystick that promises better range of motion and more comfortable use compared to the wrist twisting often required with conventional ureteroscopes. “A robotic ureteroscope will be able to make movements we currently can’t make with our ureteroscopes,” said presenter Ben H. Chew, MD, MSc, who will feature a video of the technology during this session. Dr. Chew, director of clinical research at the Stone Center at Vancouver General Hospital and associate professor of urology at the University of British Columbia, Vancouver, Canada, will also preview the features and benefits of a ureteroscope with laser automation. 

“There’s one on the market in Europe now that uses [artificial intelligence] to determine whether you’re actually on the stone or not,” Dr. Chew said. “If you’re not on the stone, the laser won’t fire.” 

This type of laser automation will offer potential safety benefits, and future artificial intelligence advances will aim to automatically set the laser to ideal settings to fragment the stone. 

“Urologists are busy and we all don’t necessarily have time to … investigate the best settings. If the robot can figure this out for us, it will make things easier [especially] if the laser can adjust itself as you start lasering the stone,” Dr. Chew said. 

Second-generation single-use digital ureteroscopes that offer better resolution, imaging and contrast will also be a focus of Saturday’s session. “When you’re lasering, you get flashes of light—it’s like looking into the sun—and the contrast of the image can make things very dark. These ureteroscopes will correct that,” Dr. Chew said. 

A single-use ureteroscope with improved resolution that measures intrarenal pressure was recently approved for use in Canada. It’s hypothesized that elevated intrarenal pressure results in more postoperative pain and an increased risk of infection. “But we don’t know what a safe pressure is. This ureteroscope will afford us the ability to do more studies. We need more information,” Dr. Chew said. 

Generally, single-use ureteroscopes offer a number of advantages compared to reusable ureteroscopes, including a 100% deflection and being clean and ready to go—as long as you have them stocked. Still, are they a smart financial move for your practice? Dr. Chew will offer a cost-analysis of single-use versus reusable ureteroscopes. 

“One downside to single-use ureteroscopes is the environmental cost. From a user standpoint, it always feels bad to throw something in the trash after every case,” Dr. Chew said. From a financial perspective, however, Dr. Chew will offer a “magic number,” a caseload threshold that determines when single-use ureteroscopes become more cost-effective, based on the literature.