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Objective: This study aimed to evaluate the pelvicalyceal anatomy on accessibility of reusable flexible ureteroscopy (fURS) to the lower pole calyx during retrograde intrarenal surgery (RIRS). Methods: Here, 854 patients with ureteral or kidney stones with access to a renal collecting system using reusable fURS were classified into either the accessible group, in whom the deepest lower pole calyces could be touched; and the inaccessible group, in whom the deepest lower calyces could not be touched. We measured the infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height (CPH) using retrograde pyelograms and performed intergroup comparisons. Results: The median IPA, IW, IL, and CPH in the accessible and inaccessible group were 60.5° and 45.6° (p < 0.001), 10.8 and 9.4 mm (p < 0.001), 33.2 and 36.4 mm (p < 0.001), and 25.9 and 30.9 mm (p < 0.001), respectively. IPA (OR 0.963, 95% CI 0.952–0.974, p < 0.001) and IW (OR 0.519, 95% CI 0.331–0.816, p = 0.004) were significant risk factors of renal pelvicalyceal anatomy related to the accessibility of the lower pole calyces. The cut‐off value for IPA and IW was 45.8°(p < 0.001) and 7.8 mm (p < 0.001), respectively. Conclusions: IPA < 45.8° and IW <7.8 mm were negative predictors to access the lower pole calyces when using reusable fURS during RIRS. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the efficacy of a high-power holmium laser with Moses technology (MT) for the treatment of lower pole stones during retrograde intrarenal surgery (RIRS). Methods: Herein, 305 patients with lower pole stones who underwent RIRS using a high-power holmium laser with MT were retrospectively classified into the stone-free (SF) and non-SF groups. We measured the stone burden, stone volume, stone hardness, pre- or post-operative stent placement, infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height in terms of pelvicalyceal anatomy using retrograde pyelograms and evaluated the predictive factors of postoperative SF. Results: A total of 173 (56.7%) and 229 (75.1%) patients achieved a SF status on postoperative day one and at one month, respectively. Operation time in the SF group was shorter than that in the non-SF group (51.0 vs. 74.5 min). There were no significant differences in postoperative complications between the SF and non-SF groups. Significantly predictive risk factors in postoperative SF included total stone volume (odds ratio (OR), 1.056; 95% CI, 1.015–1.099; p = 0.007), IPA (OR, 0.970; 95% CI, 0.956–0.993; p = 0.009), and IW (OR, 0.295; 95% CI, 0.121–0.718; p = 0.007). The cut-off values of stone volume, IPA, and IW were 515.2 mm3, 46.8°, and 7.75 mm, respectively. Conclusions: A high-power holmium laser with MT in lower pole stones is a valuable option for positive outcomes and patient's safety. Larger stone volume, acute IPA, and narrow IW were negative predictors related to postoperative SF status. [ABSTRACT FROM AUTHOR]

Objectives: A pre‐equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot‐assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. Patients and Methods: A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. Results: The FTPT was significantly shorter in the OTA group than the open group (P <.0001). The modified method was associated with a shorter FTPT (P =.0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. Conclusions: OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP. [ABSTRACT FROM AUTHOR]