Impact of Intraoperative Digital Stone Measurement on Surgeon Decision Making in Ureteroscopy

To assess the clinical use of a novel software capable of accurately measuring stone fragments in real-time and its impact on intraoperative decision-making.

Adult patients undergoing flexible ureteroscopy and holmium laser lithotripsy for renal stones were prospectively enrolled. Intraoperative measurements of fragments were performed live and reported to surgeons upon request during surgery. After each case, surgeons were surveyed about the reasons for taking measurements and how the measurements impacted their intraoperative decisions.

Among 106 patients undergoing ureteroscopy, surgeons took an average of 2.4 intraoperative measurements per case. The software was deployed successfully in all cases. Surgeons' most frequent reason for taking intraoperative measurements was to determine whether postlithotripsy fragments were extractable (52%), but they also requested measurements to assess stone size (30%) and extractability (34%) before lithotripsy. Based on stone measurements, surgeons changed intraoperative plans in 28% of cases and instead continued lithotripsy (11%), extracted fragments (14%), or left fragments behind for passage (3%). Surgeons rated the ability to take intraoperative measurements as "very helpful" (61%) or "somewhat helpful" (38%). The time burden of taking measurements affected procedural efficiency in 3% of cases.

The ability to take stone measurements during flexible ureteroscopy changed surgeons' intraoperative stone management decisions in 28% of cases. Integrating digital measurement tools may improve procedural efficiency and reduce fragment extraction failures and the risk of ureteral injury.