Endoscopic Valves and Irrigation Devices for Flexible Ureteroscopy: Is There a Difference?

Area of Science:

• Urology
• Medical Devices
• Surgical Technology

Background:

• Ureteroscopic irrigation systems vary, including gravity-driven and hand-operated pumps.
• Endoscopic valves are crucial for maintaining a watertight seal during ureteroscopy (URS).
• The clinical utility and ergonomics of these devices remain largely unestablished.

Purpose of the Study:

• To systematically compare the mechanical properties and usability of select endoscopic valves and hand-operated irrigation systems.
• To evaluate in vitro performance characteristics relevant to ureteroscopic procedures.

Main Methods:

• In vitro testing of four endoscopic valves (UroSeal, Gyrus ACMI adjustable, Gyrus ACMI Blue Silicone Seal, ACMI REF ABP).
• Usability assessment included insertion/extraction forces and times for various instruments.
• Flow rate, flow time, and user fatigue were evaluated for two irrigation systems (Boston Scientific SAP, Utah Medical Products PP).

Main Results:

• The UroSeal valve demonstrated the shortest instrument insertion times and required the least force for instrument withdrawal.
• UroSeal maintained a leak-free seal up to 200 mm Hg, outperforming other valves.
• The SAP irrigation system provided higher flow rates but caused significant operator grip fatigue, unlike the PP system.

Conclusions:

• The UroSeal valve offers advantages in instrument manipulation and maintaining a watertight seal.
• The Pathfinder Plus irrigation system provides ease of use and reduces operator fatigue.
• Further research is needed to correlate irrigation system performance with clinical outcomes.