Simulation-based dosimetric analysis of surgeon radiation exposure during robotic-assisted versus conventional URS

Fluoroscopy during urinary stone surgery exposes patients and operating staff to ionizing radiation. This study aims to model and estimate surgeon radiation dose in robotic-assisted versus conventional ureteroscopy (URS) using an experimental simulation to evaluate the potential safety advantages of robotic systems.

A simulation-based dosimetric model was developed using retrospective fluoroscopy data from 35 clinical cases. Fluoroscopy time was divided into robotic-assisted and non-robotic-assisted phases. Radiation exposure was estimated using a three-stage simulation model at four positions: the patient plane near the X-ray tube (A), and three surgeon positions including 50 cm unshielded (B), 50 cm with lead protection (C), and 150 cm behind a mobile lead barrier (D). Exposure was calculated across five scenarios: Scenario 1 (Patient Mode [Reference Measurement], position A), Scenario 2 (Conventional Unprotected Mode, position B), Scenario 3 (Conventional Protected Mode, position C), Scenario 4 (Robotic-Assisted Partial Protection Mode; B non-robotic-assisted, D robotic-assisted), and Scenario 5 (Robotic-Assisted Full Protection Mode; C non-robotic-assisted, D robotic-assisted). Data were analyzed using t-test, Mann-Whitney U, and chi-square tests, and presented as median (IQR) or n (%).

Among 35 patients (mean age 46.6 ± 15.0 years) whose clinical data were utilized for the model, the mean total fluoroscopy time was 18.6 ± 10.1 s (5.2 ± 3.4 s robotic-assisted phase). The simulated radiation exposure differed significantly across scenarios (p < 0.05), with median estimated doses of 160,101.80, 56.93, 9.07, 40.88, and 6.97 µSv for Scenarios 1-5, respectively.

Under simulated conditions, robotic-assisted URS significantly reduces surgeon radiation exposure. Specifically, the combination of increased distance and shielding minimizes these estimated dose levels.