Posters and Publications
The New Generation Kosin Universal Piggy Back Irrigation System (UPBIS) Achieves Equivalent Ureteroscopic Irrigant Flow Rates with Superior Ergonomic Hand Control
#106
Michael C. Ost, M.D, Ardeshir R. Rastinehad, D.O
Avtar Dhindsa, M.D, and Benjamin R. Lee, M.D
Dept of Urology, North Shore-Long Island Jewish Medical Center,
New Hyde Park, New York, U.S.A
Introduction
Pressure irrigation is often needed to maintain adequate visualization during various ureteroscopic procedures. Increasing Irrigant pressure gradients may be achieved by raising the height of the infused irrigant, inflating a pressure cuff around the irrigation bag, or utilizing a hand-pressure control system. We sought to evaluate if the Kosin Universal Piggy Back Irrigation System (UPBIS) (Figure 1) could achieve equivalent ureteroscopic irrigant flow rates to other available hand-pressure control systems or offer an ergonomic advantage.
Materials and Methods
Irrigation flow rates (L/hr) of three ureteroscopic hand-pressure irrigation systems (Kosin UPBIS, Boston Scientific SAPS, and Path Finger) were measured through a 2F ureteroscope ex-vivo. Irrigation flow rates were measured at an irrigant (0.9% normal Saline) height of 4 ft. when 150 mmHg weere applied. Three urologists were asked their opinon on the ergonomic advantage(s), if any, of the Kosin UPBIS when used en-vivo during ureteroscopic holmium laser ablation of upper tract transitional cell carcinoma (UTTCC).
Results
There were no differences in average ureteroscopic flow rates (L/hr) between the Kosin UPBIS, Boston Scientific SAPS, andPath Finder devices at irrigation height of 4 ft (0.81, 0.86, 0.87, respectively) or at 4ft with 150mmHg of hand pressure (2.32, 2.34, 2.27, respectively) (Figure 2). Urologists felt the Kosin UPBIS could be easily utilized during laser UTTCC resection without the help of an assistant. Minimal hand force was needed to generate adequate irrigation pressure, contrary to what was experienced when generating irrigation pressure with the Pathfinder device).
Conclusions
The Kosin UPBIS ureteroscopic irrigation system achieves equivalent flow rates to other available hand pressure irrigation systems. Added advantages of this new generation hand pressure irrigation device include superior ergonomic hand control and maximizing hand working element organization without the need of a surgical assistant.
Figure 1
Figure 2
A NOVEL DEVICE TO REDUCE TIME REQUIRED IN IRRIGATION MANAGEMENT DURING SEMI-RIGID URETEROSCOPIC LITHOTRIPSY
Joesph V. Ditrolio, Michael D. LaSalle, Rahuldev Bhalla
Saint Barnabas Medical Center, Livingston, NJ and University of Medicine and Dentistry of New Jersey, Newark, Nj
Results
Time required to manage irrigating fluids in the standard stopcock fashion was compared to utilization of the Kosin Device. Operative irrigation showed the reduction from approximately 20 percent to 10 percent of the total operative time. Reduction in operative time was directly attributed to better fluid management, better visibility and increased dexterity. Added benefits were the ability to leave one hand available continuously for lithotripsy treatment. Less time required pursuing stone fragments due to over aggressive irrigation.
Methods
Semi-rigid ureteroscopy performed with the pressure-bag irrigation was evaluated for intraoperative time required to control irrigating fluids during ureteroscopic lithotripsy. The percentage of total operative time was calculated comparing the standard procedure of stopcock adjustment to using the Classic Universal Piggyback Irrigation System produced by Kosin Technologies.
Introduction
Control of irrigation fluid during ureteroscopy and lithotripsy consumes approximately twenty percent of the operative time. The objective of this study was to evaluate a more efficient control of irrigation fluids; therefore, reducing the operative time required to treat ureteral calculi endocopically.
Conclusion
Better fluid management using a device that is structurally attached to the semi-rigid ureteroscope allows for one hand manipulation of both the scope and irrigation fluid, allowing the second hand to be directed to the lithotripsy management. Reduction in operating time is directly related to decreased fluid management time, better visibility and less stone migration because of better control of fluid management.
IMPACT OF IRRIGATION SYSTEMS ON STONE MIGRATION
Kari Hendlin, Derek Weiland, manoj Monga
Department of Urologic Surgery
University of Minnesota, Minneapolis, MN USA
Objective
To evaluate forces exerted on a stone with different ureteroscopic irrigation systems.
Materials & Methods
- A 3mm steel simulated stone was welded to a 3F stone basket and inserted into the working channel of a 4.5F Wolf semi-rigid ureteroscope.
- The basket shaft was attached to a miniature 50g load cell (Sensotec, Columbus, OH).
- The ureteroscope was placed in a ureteral model (14Fr silicon tubing).
- Simulated blood (McCormick Red Dye, (diluted 1:300) was dripped into the ureteral model adjacent to the stone through a 24 gauge needle at a rate of 0.6 mL/minute.
- Endo-irrigation devices were attached to the ureteroscope and irrigation applied at a rate sufficient to maintain visualization of the stone.
Force on the stone was measured with the following endo-irrigation systems:
- Gravity (183cm H2O), pressurized irrigation (150mmHg, 300mmHg)
- EMS Medical Peditrol Foot Pump
- Cook Ureteroscopy irrigation system
- ACMI Irri-Flo Irrigation Delivery System
- Boston Scientific Single-Action-Pump System (SAP)
- Kosin Technology Universal Piggyback Irrigation System (UPIS) at gravity (183 cm H2O), 150mmHg and 300mmHg
The average maximum impulse during a pump was significantly greater with the hand-held and foot-pump devices compared to gravity-based systems at all pressures, p<0.02.
Of the hand-held devices, the Single Action Pump exerts the least amount of total maximum impulse.
CONCLUSIONS
Gravity-based systems exert less force than hand-held and foot-pump devices.
Of the hand-held devices, the Single Action Pump exerts the least total maximum impulse on the stone.