Toward Respiratory-Gated Retrograde Intrarenal Surgery: A Prospective Controlled Randomized Study

Area of Science:

• Urology
• Anesthesiology
• Surgical Innovation

Background:

• Retrograde intrarenal surgery (RIRS) is a common procedure for kidney stones.
• Optimizing surgical conditions during RIRS is crucial for improving outcomes.
• Ventilation strategies during general anesthesia may impact surgical field dynamics.

Purpose of the Study:

• To investigate if low ventilation (LV) general anesthesia reduces renal mobility during RIRS compared to standard ventilation (SV).
• To determine the impact of LV on surgical effectiveness, including fragmentation, removal, and operating rates.
• To assess the influence of LV on surgeon performance and patient safety during RIRS.

Main Methods:

• A prospective randomized controlled trial involving 60 patients undergoing RIRS.
• Patients were randomized to receive either standard ventilation (SV) or low ventilation (LV) general anesthesia.
• Surgical endpoints including fragmentation rate (FR), removal rate (RR), processing rate (PR), and operating rate (OR) were analyzed, considering surgeon expertise.

Main Results:

• LV significantly improved FR, RR, and PR in multivariate analysis.
• LV positively influenced surgical endpoints for both novice and expert surgeons, narrowing the performance gap.
• While end-tidal CO2 was higher in the LV group, it had no clinical significance, and patient safety was maintained.

Conclusions:

• Low ventilation (LV) during RIRS significantly enhances surgical performance and effectiveness.
• LV anesthesia does not negatively impact patient safety during RIRS.
• LV may be particularly beneficial for improving the performance of in-training endourologists.