AUA 2019: Prospective Randomized Comparison of Standard Hand Pump Irrigation and an Automated Irrigation System (Thermedx ® FluidSmart ™) for Operative Efficiency during Percutaneous Nephrolithotomy: Initial Experience

Chicago, IL ( Consistent irrigation is imperative during stone procedures as they need to provide a clear camera view during procedures. Without good irrigation, blood and stone debris can disrupt the endoscopic view.

Jefferson and colleagues report their initial experience with an automated irrigation system (Thermedx ® FluidSmart™) used during percutaneous nephrolithotomy (PCNL) procedures.  They did a head to head comparison between the automated irrigation system and the traditional hand-pump irrigation system. Their primary outcomes were to look at procedural efficiency, and nurse and surgeon satisfaction.

Twelve patients undergoing PCNL were randomized to either the Thermedx or manual hand-pump (6 in each arm). A laboratory assistant was present in the operating room to record times that nurses spent setting up the irrigation systems preoperatively. Time servicing the pump intraoperatively were also recorded. Any verbally raised irrigation-related issues were recorded. Postoperatively, surgeons and nurses completed one question postoperative surveys to assess the quality of the irrigation system they had just worked with.

For the twelve patients, data analysis showed that total time setting up the Thermedx and the total time spend servicing the automated pump were significantly less than the times required to set up and service the manual hand-pump irrigation system. To be sure, nurses spent 17% more time at the manual hand-pump irrigation system than with an automated irrigation system. Both surgeons and nurses rated higher satisfaction with the automated irrigation pump. In conclusion, Jefferson and colleagues were able to show that during percutaneous nephrolithotomy, utilization of the automated irrigation enhanced surgeon and nurse satisfaction and decreased pump maintenance time by the circulating nurses.

Presented and written by: John Sung, Department of Urology, University of California-Irvine, @JohnM_Sung at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois