Urolithiasis is a common global condition that is on the rise. With the advancement of flexible ureteroscopy, retrograde intrarenal surgery has emerged as the fastest-growing surgical technique for ureteral and renal stones. We introduce a novel Robotic System for Flexible Ureterorenoscopic Surgery (Zamenix™, Roen Surgical, South Korea).

We aim to present the Zamenix™ System and its operation through video demonstrations.

While traditional flexible ureterorenoscopic stone surgery is minimally invasive and effective for urinary stones, it has limitations. Variability in stone access and removal exists based on the surgeon's skill level, and precise laser targeting can be challenging. Surgeons also experience increased fatigue from prolonged lead apron use and repetitive radiation exposure. The Zamenix™ System was developed to overcome these shortcomings. It integrates a flexible ureterorenoscope, laser fiber, or stone basket onto a robot, allowing the surgeon to control the robot remotely from a console using joysticks and a touchscreen. This setup enables surgeons to avoid radiation exposure and significantly reduce fatigue compared to conventional surgery. The system provides intuitive monitoring of the scope's position on a screen and can automatically re-enter previously memorized paths. It incorporates artificial intelligence to assess whether stones can pass through an access sheath and automatically retrieve stones outside the access sheath. Moreover, it synchronizes with the patient's respiratory motion to perform surgery more safely.

This new robotic system is expected to greatly advance surgeries for urolithiasis and other ureterorenoscopic procedures.