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Objectives <p>To address the literature paucity regarding the surgical outcomes with the utilization of vacuum-assisted renal access sheath (VA-RAS) versus usual miniaturized renal access sheath (RAS) in mini-percutaneous nephrolithotomy (mini-PCNL).</p> Materials and methods <p>Retrospective cohort data for patients who underwent supine mini-PCNL with the HoYAG laser platform (Lumenis Pulse P120H™, 120&#xa0;W, Boston Scientific<sup>®</sup>) between 08/2021 and 07/2024. Exclusion criteria included patients with urinary diversion, cases using any other form of stone fragmentation but laser, and those with ureteral stones. VA-RAS (ClearPetra™, MicroTech Endoscopy<sup>®</sup>, China) and RAS (MIP-M, Karl Storz<sup>®</sup>, Germany) were compared. Stone-free rate (SFR) was assessed by CT scan performed on the first postoperative day and presented as: absence of stone fragments, no fragments larger than 2&#xa0;mm, or no fragments larger than 4&#xa0;mm.</p> Results <p>A total of 111 patients met the study criteria, of which VA-RAS was used for 57 patients (51.4%). Despite higher stone volume in VA-RAS group, there was no difference in total operative time. Nevertheless, laser ablation efficiency and time to clear 1&#xa0;cm<sup>3</sup> was lower in VA-RAS group. Overall, there was no difference in SFR between VA-RAS and RAS (no fragments: RR 1.3, CI 95% 0.9–1.8, <i>p</i> = 0.11; fragments &lt; 2&#xa0;mm: RR 1.1, CI 95% 0.8–1.4, <i>p</i> = 0.68; fragments &lt; 4&#xa0;mm: RR 1.2, CI 95% 0.9–1.5, <i>p</i> = 0.09).</p> Conclusion <p>We observed an equivalent postoperative SFR, total operative time and laser ablation speed when comparing VA-RAS and RAS in mini-PCNL. However, we observed a higher laser ablation efficiency and lower time clear 1&#xa0;cm<sup>3</sup> of stone with VA-RAS group.</p>

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Vacuum-assisted renal sheath clears 1 cm3 of stone faster than non-suction sheath in mini-percutaneous nephrolithotomy

  • 期刊论文

  • 发表日期：

    2025年5月8日

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  • Lucas B. Vergamini,
  • Bristol B. Whiles,
  • Amber McMahon,
  • Michael Creswell,
  • Jared Starkey,
  • Jill Smith,
  • Mihaela E. Sardiu,
  • Donald A. Neff,
  • David A. Duchene,
  • Wilson R. Molina

摘要

Objectives

To address the literature paucity regarding the surgical outcomes with the utilization of vacuum-assisted renal access sheath (VA-RAS) versus usual miniaturized renal access sheath (RAS) in mini-percutaneous nephrolithotomy (mini-PCNL).

Materials and methods

Retrospective cohort data for patients who underwent supine mini-PCNL with the HoYAG laser platform (Lumenis Pulse P120H™, 120 W, Boston Scientific®) between 08/2021 and 07/2024. Exclusion criteria included patients with urinary diversion, cases using any other form of stone fragmentation but laser, and those with ureteral stones. VA-RAS (ClearPetra™, MicroTech Endoscopy®, China) and RAS (MIP-M, Karl Storz®, Germany) were compared. Stone-free rate (SFR) was assessed by CT scan performed on the first postoperative day and presented as: absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm.

Results

A total of 111 patients met the study criteria, of which VA-RAS was used for 57 patients (51.4%). Despite higher stone volume in VA-RAS group, there was no difference in total operative time. Nevertheless, laser ablation efficiency and time to clear 1 cm3 was lower in VA-RAS group. Overall, there was no difference in SFR between VA-RAS and RAS (no fragments: RR 1.3, CI 95% 0.9–1.8, p = 0.11; fragments < 2 mm: RR 1.1, CI 95% 0.8–1.4, p = 0.68; fragments < 4 mm: RR 1.2, CI 95% 0.9–1.5, p = 0.09).

Conclusion

We observed an equivalent postoperative SFR, total operative time and laser ablation speed when comparing VA-RAS and RAS in mini-PCNL. However, we observed a higher laser ablation efficiency and lower time clear 1 cm3 of stone with VA-RAS group.