Ureteroscopy has surpassed extracorporeal shockwave lithotripsy (ESWL) to become the predominant method for kidney stone management. However, conventional flexible ureteroscopy (URSL) poses several challenges, including surgeon fatigue (thumb, shoulder, wrist pain, carpal tunnel syndrome, knee pain), radiation exposure, respiratory-induced stone movement, mucosal trauma, and device limitations. Recently developed robotic systems, such as those offering respiratory synchronization, ergonomic support, and intra-renal monitoring, aim to address these limitations. Techniques to minimize respiratory motion during lithotripsy include high-frequency ventilation, intraoperative apnea, abdominal compression, and low tidal volume anesthesia.

A 55-year-old woman presented with left abdominal pain. Computed tomography identified a 1.2 cm renal stone in the upper pole of the left kidney. The patient underwent Respiratory-Synchronized Laser Lithotripsy using the Zamenix™ Robotic Retrograde Intrarenal Surgery (RIRS) System.

The procedure achieved successful stone fragmentation with no mucosal injury. Docking time was 5 minutes, operative time was 35 minutes, and laser activation time was 10 minutes. Postoperative recovery was uneventful with no complications. Follow-up imaging (KUB) showed complete stone clearance.

Our initial experience demonstrates that respiratory synchronization in robotic-assisted RIRS significantly reduces operative and laser times, minimizes mucosal trauma, and enhances overall procedural efficiency and patient safety.