Ee Jean Lim, Bhaskar Kumar Somani, Mehmet Ilker Gokce, Chin Tiong Heng, Ashish Ranjan Satapathy, Jose Ivan Robles, Tsung Wen Chong, Khi Yung Fong, Daniele Castellani, Naeem Bhojani, Hatem Kamkoum, Nariman Gadzhiev, Vigen Malkhasyan, Von Vee Ng, Saeed Bin Hamri, Steffi Kar-Kei Yuen, Thomas R W Herrmann, Oliver Traxer, Vineet Gauhar
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This study evaluates the impact of gated respiration on perioperative outcomes in RIRS with FANS.</p><p><strong>Methods: </strong>A prospective multicenter study enrolled 562 adult patients undergoing RIRS with FANS under general anesthesia. Patients were divided into two groups: non-gated respiration (Group 1) and gated respiration (Group 2). Stone-free status (SFS) was assessed at 30 days using NCCT scans. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤ 2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments > 4 mm. Procedural efficiency, perioperative complications, and surgeon-reported outcomes were compared.</p><p><strong>Results: </strong>Patients in Group 2 had significantly higher zero residual fragment (Grade A) rates (64.2% vs. 59%) and overall SFR (Grade A + B: 98.3% vs. 91.3%, p = 0.001). Gated respiration improved sheath navigation (91.2% vs. 85.1%, p = 0.038) and visibility during lithotripsy (p = 0.004), while reducing complications like mild bleeding due to sheath movement (3.1% vs. 11.2%, p < 0.001). Logistic regression identified gated respiration as a significant predictor of SFS (OR 6.26, 95% CI 2.28-22.6, p < 0.001).</p><p><strong>Conclusion: </strong>Gated respiration synergistically enhances the efficacy of FANS in RIRS, improving SFR, procedural safety, and surgeon experience. This study highlights the importance of respiratory control as an adjunct to RIRS, emphasizing the need for interdisciplinary collaboration between surgical and anesthesiology teams.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"110"},"PeriodicalIF":2.9000,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"General anaesthesia with gated or controlled mechanical ventilation and its influence on peri and post operative outcomes of retrograde intra renal surgery when using flexible and navigable suction access sheath, an EAU-endourology and Global FANS collaborative study group: a prospective study.\",\"authors\":\"Ee Jean Lim, Bhaskar Kumar Somani, Mehmet Ilker Gokce, Chin Tiong Heng, Ashish Ranjan Satapathy, Jose Ivan Robles, Tsung Wen Chong, Khi Yung Fong, Daniele Castellani, Naeem Bhojani, Hatem Kamkoum, Nariman Gadzhiev, Vigen Malkhasyan, Von Vee Ng, Saeed Bin Hamri, Steffi Kar-Kei Yuen, Thomas R W Herrmann, Oliver Traxer, Vineet Gauhar\",\"doi\":\"10.1007/s00345-025-05488-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Retrograde intrarenal surgery (RIRS) is a preferred treatment for renal stones, yet challenges such as kidney movement due to respiration hinder surgical precision and outcomes. The introduction of flexible and navigable suction ureteral access sheaths (FANS) and novel techniques like gated respiration aim to improve stone-free rates (SFR) and reduce complications. This study evaluates the impact of gated respiration on perioperative outcomes in RIRS with FANS.</p><p><strong>Methods: </strong>A prospective multicenter study enrolled 562 adult patients undergoing RIRS with FANS under general anesthesia. Patients were divided into two groups: non-gated respiration (Group 1) and gated respiration (Group 2). Stone-free status (SFS) was assessed at 30 days using NCCT scans. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤ 2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments > 4 mm. Procedural efficiency, perioperative complications, and surgeon-reported outcomes were compared.</p><p><strong>Results: </strong>Patients in Group 2 had significantly higher zero residual fragment (Grade A) rates (64.2% vs. 59%) and overall SFR (Grade A + B: 98.3% vs. 91.3%, p = 0.001). Gated respiration improved sheath navigation (91.2% vs. 85.1%, p = 0.038) and visibility during lithotripsy (p = 0.004), while reducing complications like mild bleeding due to sheath movement (3.1% vs. 11.2%, p < 0.001). Logistic regression identified gated respiration as a significant predictor of SFS (OR 6.26, 95% CI 2.28-22.6, p < 0.001).</p><p><strong>Conclusion: </strong>Gated respiration synergistically enhances the efficacy of FANS in RIRS, improving SFR, procedural safety, and surgeon experience. This study highlights the importance of respiratory control as an adjunct to RIRS, emphasizing the need for interdisciplinary collaboration between surgical and anesthesiology teams.</p>\",\"PeriodicalId\":23954,\"journal\":{\"name\":\"World Journal of Urology\",\"volume\":\"43 1\",\"pages\":\"110\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-02-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00345-025-05488-6\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00345-025-05488-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：逆行肾内手术（RIRS）是肾结石的首选治疗方法，但由于呼吸引起的肾脏运动等挑战阻碍了手术的准确性和结果。引入灵活和可导航的输尿管吸入鞘（FANS）和门控呼吸等新技术旨在提高结石清除率（SFR）并减少并发症。本研究评估门控呼吸对合并fan的RIRS患者围手术期预后的影响。方法：一项前瞻性多中心研究，纳入562例全身麻醉下接受RIRS和FANS的成年患者。患者分为两组：非门控呼吸（第1组）和门控呼吸（第2组）。30天通过NCCT扫描评估无结石状态（SFS）。SFS定义为：A级，零碎片；B级，单碎片≤2mm；C级，单片2.1-4 mm；D级，单片/多片> 4mm。比较手术效率、围手术期并发症和手术报告结果。结果：组2患者的零残留碎片（A级）率（64.2% vs. 59%）和总SFR （A + B级：98.3% vs. 91.3%, p = 0.001）显著高于组2。门控呼吸改善了鞘鞘导航（91.2% vs. 85.1%, p = 0.038）和碎石时的能见度（p = 0.004），同时减少了鞘鞘运动引起的轻度出血等并发症（3.1% vs. 11.2%, p）。结论：门控呼吸可协同增强FANS在RIRS中的疗效，提高SFR、手术安全性和外科医生经验。本研究强调了呼吸控制作为RIRS辅助手段的重要性，强调了外科和麻醉学团队之间跨学科合作的必要性。
General anaesthesia with gated or controlled mechanical ventilation and its influence on peri and post operative outcomes of retrograde intra renal surgery when using flexible and navigable suction access sheath, an EAU-endourology and Global FANS collaborative study group: a prospective study.
Background: Retrograde intrarenal surgery (RIRS) is a preferred treatment for renal stones, yet challenges such as kidney movement due to respiration hinder surgical precision and outcomes. The introduction of flexible and navigable suction ureteral access sheaths (FANS) and novel techniques like gated respiration aim to improve stone-free rates (SFR) and reduce complications. This study evaluates the impact of gated respiration on perioperative outcomes in RIRS with FANS.
Methods: A prospective multicenter study enrolled 562 adult patients undergoing RIRS with FANS under general anesthesia. Patients were divided into two groups: non-gated respiration (Group 1) and gated respiration (Group 2). Stone-free status (SFS) was assessed at 30 days using NCCT scans. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤ 2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments > 4 mm. Procedural efficiency, perioperative complications, and surgeon-reported outcomes were compared.
Results: Patients in Group 2 had significantly higher zero residual fragment (Grade A) rates (64.2% vs. 59%) and overall SFR (Grade A + B: 98.3% vs. 91.3%, p = 0.001). Gated respiration improved sheath navigation (91.2% vs. 85.1%, p = 0.038) and visibility during lithotripsy (p = 0.004), while reducing complications like mild bleeding due to sheath movement (3.1% vs. 11.2%, p < 0.001). Logistic regression identified gated respiration as a significant predictor of SFS (OR 6.26, 95% CI 2.28-22.6, p < 0.001).
Conclusion: Gated respiration synergistically enhances the efficacy of FANS in RIRS, improving SFR, procedural safety, and surgeon experience. This study highlights the importance of respiratory control as an adjunct to RIRS, emphasizing the need for interdisciplinary collaboration between surgical and anesthesiology teams.
期刊介绍：
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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