UCI Health tests novel technology to remove small and large kidney stones in a single procedure
April 13, 2023
"We are thrilled to be a part of this first clinical trial
and to be introducing a new treatment to improve
outcomes for kidney stone patients in need,” said
Dr. Jaime Landman, director of the UCI Health Kidney
Stone Center. Photo by Erik Ostling/UCI Health
UCI Health has performed the first U.S. robot-assisted surgery to successfully remove kidney stones with ureteroscopic and percutaneous nephrolithotomy procedures simultaneously.
The surgery was the first in a Johnson & Johnson-sponsored clinical trial to test the Monarch™ urology platform, which allows the urologist to perform both robot-assisted electromagnetic-guided percutaneous and mini-percutaneous nephrolithotomy (PCNL).
"This clinical study is the first in the world to research and demonstrate the potential for improved navigation, access, clearance and control in mini PCNL procedures using the MONARCH platform,” said UCI Health Kidney Stone Center Director Jaime Landman, MD, who performed the surgery and is the clinical trial's principal investigator.
"In addition to potentially helping urologists achieve stone-free patients in a single procedure, this approach could help reduce the need for retreatment after kidney stone removal and decrease risks and complication rates," added Landman, principal investigator for the Monarch study and chair of the UCI School of Medicine's Department of Urology.
The UCI Health Center for Urologic Care has a long history of pioneering novel procedures and technologies to treat kidney stone disease. Landman has been part of six-year project to develop the MONARCH device.
The surgical platform — developed by Ethicon, a Johnson & Johnson MedTech company, in collaboration with trial co-investigator Mihir M. Desai, MD, a urologist at Keck Medicine of USC — is designed to allow urologists to navigate within the kidney using a handheld controller that precisely maintains instrument positions and gives surgeons the ability to perform multiple tasks.
The device was cleared for use in kidney stone procedures by the U.S. Food and Drug Administration in spring 2022. The current clinical study will gather performance data on robot-assisted mini-PCNL procedures in order to optimize the platform and inform physician training and education.
About one in 11 Americans will develop a kidney stone in their lifetime and many require multiple treatments for kidney stones.
"The prevalence of kidney stones remains high and many urologists seek a new treatment option that reduces overall retreatment and complication rates," said Desai. "In patients who require treatment through surgery, nearly half will need another treatment within five years."
Ureteroscopy is the most common way to surgically remove kidney stones but is challenging to use when removing larger stones. PCNL achieves superior stone clearance in patients with larger kidney stones, but it is used in only 7% to 8% of U.S. kidney stone removals.
The benefit of the MONARCH platform is that it gives urologists superior control and the ability to use PCNL if ureteroscopy alone isn’t sufficient to clear the stones.
In addition, when compared to standard fluoroscope-guided access techniques, patients are exposed to 80% less radiation and fewer needle sticks.
"After years of work, we are thrilled to be a part of this first clinical trial and to be introducing a new treatment to improve outcomes for kidney stone patients in need,” Landman said.
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