Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept
Objective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently ava...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-06-01
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| Series: | Therapeutic Advances in Urology |
| Online Access: | https://doi.org/10.1177/17562872231179332 |
| _version_ | 1827917506355920896 |
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| author | Jia-Lun Kwok Vincent De Coninck Amelia Pietropaolo Patrick Juliebø-Jones Eugenio Ventimiglia Thomas Tailly Florian Alexander Schmid Manuela Hunziker Cédric Poyet Olivier Traxer Daniel Eberli Etienne Xavier Keller |
| author_facet | Jia-Lun Kwok Vincent De Coninck Amelia Pietropaolo Patrick Juliebø-Jones Eugenio Ventimiglia Thomas Tailly Florian Alexander Schmid Manuela Hunziker Cédric Poyet Olivier Traxer Daniel Eberli Etienne Xavier Keller |
| author_sort | Jia-Lun Kwok |
| collection | DOAJ |
| description | Objective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods: IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results: IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector ( p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS ( R 2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions: IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties. |
| first_indexed | 2024-03-13T03:29:48Z |
| format | Article |
| id | doaj.art-db2dd722fb164d4fb62c4aa65ea7d13f |
| institution | Directory Open Access Journal |
| issn | 1756-2880 |
| language | English |
| last_indexed | 2024-03-13T03:29:48Z |
| publishDate | 2023-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Urology |
| spelling | doaj.art-db2dd722fb164d4fb62c4aa65ea7d13f2023-06-25T02:33:50ZengSAGE PublishingTherapeutic Advances in Urology1756-28802023-06-011510.1177/17562872231179332Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new conceptJia-Lun KwokVincent De ConinckAmelia PietropaoloPatrick Juliebø-JonesEugenio VentimigliaThomas TaillyFlorian Alexander SchmidManuela HunzikerCédric PoyetOlivier TraxerDaniel EberliEtienne Xavier KellerObjective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods: IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results: IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector ( p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS ( R 2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions: IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.https://doi.org/10.1177/17562872231179332 |
| spellingShingle | Jia-Lun Kwok Vincent De Coninck Amelia Pietropaolo Patrick Juliebø-Jones Eugenio Ventimiglia Thomas Tailly Florian Alexander Schmid Manuela Hunziker Cédric Poyet Olivier Traxer Daniel Eberli Etienne Xavier Keller Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept Therapeutic Advances in Urology |
| title | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept |
| title_full | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept |
| title_fullStr | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept |
| title_full_unstemmed | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept |
| title_short | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept |
| title_sort | instrumental dead space and proximal working channel connector design in flexible ureteroscopy a new concept |
| url | https://doi.org/10.1177/17562872231179332 |
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