Standardizing Suction Ureteral Access Sheath Technique in Retrograde Intrarenal Surgery (RIRS): Tips, Tricks &...

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Suction ureteral access sheaths (S-UAS) offer advantages over traditional UAS in retrograde intrarenal surgery (RIRS).
• Standardization of S-UAS technique is crucial due to technical complexities.
• Limited instructional resources exist for S-UAS implementation.

Purpose of the Study:

• To present an instructional video detailing the setup, operative choreography, and troubleshooting of suction ureteral access sheaths (S-UAS).
• To standardize the technique for using S-UAS in RIRS, particularly for large renal stones.
• To improve stone-free rates and reduce complications associated with RIRS.

Main Methods:

• Instructional video demonstrating S-UAS setup with a closed-loop, pressure-aware system.
• Detailed operative choreography including sheath positioning, laser strategy (dusting/fragmentation), and fragment evacuation.
• Troubleshooting algorithms for common issues like UPJ obstruction, clogging, and system collapse.

Main Results:

• Successful application of S-UAS in a case of a large pelvic stone (25-mm).
• Operative time: 115 minutes; laser time: 25 minutes.
• Post-operative day 1 CT confirmed stone-free status; patient discharged within 24 hours.

Conclusions:

• A standardized S-UAS technique is feasible and reproducible for RIRS.
• S-UAS optimizes visualization, fragment clearance, pressure control, and safety during RIRS for large stones.
• Standardization videos can enhance training, promote wider adoption, and improve RIRS outcome consistency.