AUA 2024: First Prospective Clinical Assessment of The ILY Robotic Flexible Ureteroscopy Platform.

( The 2024 American Urological Association Annual Meeting included a stone disease session featuring work from Dr. Elia Abou Chawareb and colleagues from American University of Beirut Medical Center Division of Urology presenting their first impressions of the ILY® robotic system for flexible ureteroscopy in treating kidney stones. Dr. Chawareb began his presentation by describing the robotic system as being a ureteroscopy ‘manipulator’ with a versatile capacity allowing integration with a range of ureteroscopes and ureteral access sheaths (Figure 1). The robot is controlled by an ergonomic wireless joystick controller, which they describe as being similar to that of an Xbox or PlayStation.

Figure 1: ILY® Robotic System

In this initial assessment, 31 renal units underwent ureteroscopic procedure using the ILY® robotic system. The team noted patient demographics, stone characteristics, surgical durations, perioperative and postoperative complications, and follow-up parameters (Table 1). Complication rates, surgical durations, and stone-free rate during follow-up were analyzed to assess effectiveness and safety. All patients had a 1-day postoperative stay per protocol.

Table 1: ILY® Cases Stone Characteristics and Surgical Timings


Figure 2: Access Time, Robot Draping Time, Docking Time, Console Time, and lasing Time in All ILY® Cases

A Clavian-Dindo Classification of 1 was assigned to 9.68% of the cases. These complications required an ED visit due to pain; however, Dr. Chawareb shared that the pain was attributed to the use of a double-J stent not a result of the surgery itself. The team achieved a stone-free rate of 93.55%, whereby no patients required reoperation for the treated stone. As such, the team considers these results to prove that ILY® robotic flexible ureteroscopy is safe and effective.

This presentation sparked some questions at the end of the session including one from the moderator, Dr. Ojas Shah, who was particularly impressed with the stone free rate using this technology. Dr. Chawareb confirmed that stone free rate was based on either CT or other visualization when removing the double-J stent. However, it is currently unclear what exactly makes this technology result in better stone free rates. One of the attendees asked whether an assistant is still needed at the table when using the robot, and Dr. Chawareb shared that an assistant is still required for the irrigation. He also reiterated that using the robot requires use of a ureteral access sheath.

As this study was only the first prospective clinical experience for this technology, the team certainly recognizes that additional investigations including direct comparative analyses with manual flexible ureteroscopy techniques should be the next step. Another future direction that was discussed was the implementation of AI technology to potentially “find a way back to the stone or for the purpose of following the stone automatically”, as prompted by one of the attendees. Dr. Chawareb confirmed they are currently working on implementing AI; and Dr. Albert El-Hajj added that they have already begun to segment the stones for this purpose, optimistic that “there is a possibility to apply this [AI] in the future”. Dr. El-Hajj performed many of the discussed ureteroscopies from this study and shared that “When you’re operating you’re seated and far away from the patient and sea arm. It’s quite nice actually, you get used to it”. Overall, this first clinical assessment has shown great promise in the future of ureteroscopy with its next steps clearly outlined and currently being worked on.

Presented by: Elia Abou Chawareb, Department of Urology, University of California-Irvine Medical Center, Orange, CA

Written by: Amanda McCormac, Department of Urology, University of California Irvine, @MccormacAmanda on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.