To assess the clinical use of a novel software capable of accurately measuring stone fragments in real-time and its impact on intraoperative decision-making.
Adult patients undergoing flexible ureteroscopy and holmium laser lithotripsy for renal stones were prospectively enrolled. Intraoperative measurements of fragments were performed live and reported to surgeons upon request during surgery. After each case, surgeons were surveyed about the reasons for taking measurements and how the measurements impacted their intraoperative decisions.
Among 106 patients undergoing ureteroscopy, surgeons took an average of 2.4 intraoperative measurements per case. The software was deployed successfully in all cases. Surgeons' most frequent reason for taking intraoperative measurements was to determine whether post-lithotripsy fragments were extractable (52%), but they also requested measurements to assess stone size (30%) and extractability (34%) before lithotripsy. Based on stone measurements, surgeons changed intraoperative plans in 28% of cases and instead continued lithotripsy (11%), extracted fragments (14%), or left fragments behind for passage (3%). Surgeons rated the ability to take intraoperative measurements as "very helpful" (61%) or "somewhat helpful" (38%). The time burden of taking measurements affected procedural efficiency in 3% of cases.
The ability to take stone measurements during flexible ureteroscopy changed surgeons' intraoperative stone management decisions in 28% of cases. Integrating digital measurement tools may improve procedural efficiency and reduce fragment extraction failures and the risk of ureteral injury.
Urology. 2025 Jun 27 [Epub ahead of print]
Alexander B C Krueger, Drew Marie Smith, Andrew T Parzych, Robert Qi, Aaron M Potretzke, Dan Stoianovici, David R Holmes, Mark A Lifson, Kevin Koo
Mayo Clinic Alix School of Medicine, Rochester, MN., Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, Johns Hopkins University, Baltimore, MD., Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN; Biomedical Imaging Resource, Mayo Clinic, Rochester, MN., Center for Digital Health, Mayo Clinic, Rochester, MN., Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: .