Ureteroscopy: Surgeons show techniques, tips in videos
In this video, the authors, including D. Duane Baldwin, MD, present a summary of their techniques designed to reduce radiation exposure during uncomplicated ureteroscopy. The video will show how a detailed review of preoperative imaging; use of tactile feedback and external visual cues; use of pulsed fluoroscopy if imaging should be required; use of direct vision for renal mapping; and fluoroless stent placement can all be combined in accordance with the principles of ALARA (As Low As Reasonably Achievable) to reduce radiation exposure to the patient, surgeon, and staff.
Dr. Ghani: In a very nice video, Dr. Baldwin demonstrates the technique of fluoroless ureteroscopy. While some urologists may have undertaken such a method when performing ureteroscopy on pregnant patients, fluoroless ureteroscopy as a standard method is likely to raise eyebrows. I have to credit the video for providing thought-provoking content that questions the current paradigm for ureteroscopic surgery. I for one, would love to see the day when I can ditch my heavy lead apron! As the video suggests, patients with accurate pre-operative imaging, single stones, and existing indwelling ureteral stents are the most ideal candidates. However, until we are able to assess patient outcome data—both from a safety and stone clearance perspective—it remains a controversial primary technique.
Dr. Hotaling: While not a standard technique, fluoroless ureteroscopy is a very novel approach to safely obtaining ureteral access. Employing it in selected patient populations, as the authors suggest, definitely makes sense. Many of the described techniques, such as using a paper marker on the ureteroscope to guide choice of stent length and marking the desired length of stent, can help facilitate optimal stent placement. Perhaps most importantly, this video brilliantly illustrates how careful review of preoperative imaging can facilitate a smooth and safe endoscopic case.