| Time |
Session |
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10:30
12:00
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Endourology (B)
Yi-Sheng TaiTaiwan
Moderator
Which Laser for RIRS: Thulium Fiber Laser Thulium Fiber Laser (TFL)is a type of fiber laser, distinct from Thulium laser used for prostate surgey. It’ a cutting-edge laser and rapidly gaining traction in urology The machine is compact, portable, quiet with air-cooling, and lower power consumption.It employs a thulium-doped silica fiber powered by diode lasers, emitting light at 1940 nm, matching water absorption peaks. This results in a high absorption coefficient and shallow penetration (~0.1 mm), enabling precise energy delivery and minimizing tissue damage.Compared to Holmium lasers, TFL operates at lower energies (down to 25mJ) and higher frequencies (up to 2000Hz) for delicate tissue ablation and fine stone dusting.
The most notable change is pulse modulationHo:YAG lasers has Spike-shaped pulses and indicate greater energy concentration, resulting in higher localized heating, uneven fragmentation, and increased retropulsion.TFL produces pulses with uniform energy distribution and lower peak power, resulting in consistent ablation with less retropulsion and fewer thermal spikes.Higher water absorption rapidly forms a vapor channel, enhancing ablation efficiency.
But, TFL is not as ideal in surgical scenarios. At settings of low pulse energy (0.2 J) and high frequency (100 Hz), it tends to cause troublesome char formation and spark generation, particularly when treating calcium phosphate stones. These phenomena, explosive combustion and carbonization can reduce ablation efficiency and increase the risk of thermal damage and fiber degradation. Optimizing TFL settings is very important for outcome and safety and ongoing evaluation. AI in Medical Imaging – Converting 2D Black & White to 3D and Applications in Mixed Reality (MR) used in RIRS Artificial Intelligence (AI) and Extended Reality (XR) are at the forefront of innovation in modern medicine. In endoscopic surgery, these technologies are increasingly being integrated to enhance procedural precision and intraoperative guidance.
One experimental application involves using AI to convert 2D CT scans into 3D visualizations, offering surgeons a more intuitive understanding of anatomical structures. Devices like the Apple Vision Pro may be used to create fully immersive virtual environments, although it is not currently approved as a medical device.
In clinical practice, Mixed Reality (MR)—which blends real and virtual environments with real-time interaction—has shown promise. MR has been used during Retrograde Intrarenal Surgery (RIRS) to reduce the risk of missed stones, and in Endoscopic Combined Intrarenal Surgery (ECIRS) to overlay anatomical data, improving puncture accuracy during Percutaneous Nephrolithotomy (PCN).
As an emerging field, further advancements will depend on enhanced imaging resolution, improved intrarenal navigation and integration of AI-driven real-time stone detection.
Yi-Yang LiuTaiwan
Moderator
Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required.
Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm.
Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs.
In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required.
ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
TICC - 1F 101A
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13:30
15:00
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-
Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Po-Ming ChowTaiwan
Speaker
Conventional Artificial Urinary Sphincter ImplantationA step-by-step video of a standard approach of AUS implatation is shown in this semi-live session.
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Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Véronique PhéFrance
Speaker
New Artificial Urinary SphinterStress urinary incontinence remains a major quality-of-life concern, particularly following pelvic surgery. Despite being the gold standard, the AMS 800 artificial urinary sphincter (AUS) presents significant limitations, including mechanical failure, urethral atrophy, and challenges for elderly or disabled patients. Recent innovations in AUS design now incorporate mechatronics, remote control, adaptive pressure systems, and miniaturized components aimed at improving usability, autonomy, and continence outcomes. This presentation reviews the current landscape of next-generation AUS, focusing on ARTUS, UroActive®, and other devices under clinical evaluation. We discuss preclinical and first-in-human data, regulatory pathways, patient-reported preferences, and remaining barriers such as infection risks and training requirements. Intelligent, connected AUS devices hold promise to transform continence care after decades of technological stagnation.Choosing between Laparoscopic Sacrocolpopexy and Lateral Suspension: Weighing the Pros and ConsPelvic organ prolapse (POP) is a common condition requiring surgical intervention to restore apical support. Among minimally invasive options, laparoscopic sacrocolpopexy (LSCP) remains the gold standard, while laparoscopic lateral suspension (LLS) is gaining renewed interest for its reduced invasiveness and simplified technique. This presentation compares LSCP and LLS across multiple dimensions: anatomical restoration, functional outcomes, complication profiles, patient selection, and surgical learning curves. LSCP offers robust long-term results and better posterior compartment support but carries increased operative complexity. LLS provides effective anterior/apical correction with fewer vascular risks and a shorter learning curve. Both techniques have comparable mesh exposure rates and subjective success. Individualized decision-making based on patient anatomy, comorbidities, and surgeon expertise remains key. Emerging technologies and robotic assistance may further refine these approaches in the future.Robotic Novel Artificial Urinary Sphincter ImplantationThis video shows a step by step robotic artificial urinary sphincter implantation in women using AMS800 and Artus devices.First robot-assisted implantation of ARTUS (Affluent Medical) electromechanical artificial urinary sphincter in a female cadaverIntroduction
Artificial urinary sphincters (AUS) are effective tools for the treatment of female stress urinary incontinence. Nonetheless, hydraulic sphincters present with some limitations: complex and time-consuming preparation, need for preserved manual dexterity and constant pressure exertion on the bladder neck. The ARTUS® Artificial Urinary Sphincter is a novel electro-mechanical device designed to overcome these limitations thanks to its rapid and straight-forward implantation, intuitive remotely controlled manipulation and continuously adjustable cuff pressure.
Materials and methods
The ARTUS® system is currently under pre-market investigation in men, in an interventional, prospective, single arm, multicentric, international study. A cadaver lab session was carried out in Decembre 2024 to test the technical feasibility of ARTUS® implantation in female patients. The procedure was performed by an expert surgeon with extensive experience in AUS implantation and robotic surgery.
Results
One female patient was successfully implanted during the session. The technique has been developed following the principles of the traditional robot-assisted AUS implantation: the patient is placed in gynecological 23° Trendelenburg position. The robot has a 4-arms configuration. The procedure starts with the dissection of the vesicovaginal plane, to approach the bladder neck posteriorly. The lateral surfaces of the bladder neck are developed on both sides. The anterior peritoneum is opened to gain access to the antero-lateral surfaces of the bladder. The separation of the bladder neck from the vagina is performed through dissection of the pre-vaginal fascia bilaterally. The cuff is introduced and it is passed through the antero-lateral peri-vesical spaces, sliding behind the bladder neck from the right side to the left side. The anterior peritoneum is opened to gain access to the anterior surface of the bladder neck. The cuff is closed anteriorly, passing the transmission line inside the hole at the distal part of the cuff. The tightening around the bladder neck is achieved by pulling the transmission cable through. An optimal adjustment of the cuff around the bladder neck is provided tightening the ARTUS cuff clamping notch. Then, a supra-pubic 4 cm skin incision is made to implant the control unit. The tip of the cuff is passed outside through the incision. A lodge is prepared incising along the external oblique muscle aponeurosis. The cuff is connected to the control unit and a test with the remote control is performed to verify the functioning of the system. Finally, the control unit is placed into the lodge, anchored with non-absorbable sutures to the aponeurosis.
Conclusions
Robot-assisted ARTUS® implantation is technically feasible in female patients. This straight-forward technique may reduce operative time. The device has the potential to reduce the pressure and facilitate manipulation in patients with impaired dexterity.
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Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Ching-Pei TsaiTaiwan
Speaker
Robotic/Laparoscopic Sacrocolpopexy and Pelvic Floor ReconstructionAbdominal sacrocolpopexy has been the gold standard operation for POP. Currently, the trend is minimal-invasive surgeries such as laparoscopy(LSC) or robot-assisted laparoscopy(RASC) to promote recovery. However, surgeons hesitated to do it because of longer learning curve and complicated surgical procedures. How to simplify the above operations is the most important issue.
The use of robotic assisted surgery has grown since the advent of better wrist dexterity, a 3D view, and motion scaling, which has great advantages in performing sacrocolpopexy. But the efficacy of RASC and LSC is comparable as indicated in previous studies, and the only difference is less bleeding with the RASC.
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Cheng-Chia LinTaiwan
Speaker
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
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Yi-Sheng TaiTaiwan
Speaker
Which Laser for RIRS: Thulium Fiber Laser Thulium Fiber Laser (TFL)is a type of fiber laser, distinct from Thulium laser used for prostate surgey. It’ a cutting-edge laser and rapidly gaining traction in urology The machine is compact, portable, quiet with air-cooling, and lower power consumption.It employs a thulium-doped silica fiber powered by diode lasers, emitting light at 1940 nm, matching water absorption peaks. This results in a high absorption coefficient and shallow penetration (~0.1 mm), enabling precise energy delivery and minimizing tissue damage.Compared to Holmium lasers, TFL operates at lower energies (down to 25mJ) and higher frequencies (up to 2000Hz) for delicate tissue ablation and fine stone dusting.
The most notable change is pulse modulationHo:YAG lasers has Spike-shaped pulses and indicate greater energy concentration, resulting in higher localized heating, uneven fragmentation, and increased retropulsion.TFL produces pulses with uniform energy distribution and lower peak power, resulting in consistent ablation with less retropulsion and fewer thermal spikes.Higher water absorption rapidly forms a vapor channel, enhancing ablation efficiency.
But, TFL is not as ideal in surgical scenarios. At settings of low pulse energy (0.2 J) and high frequency (100 Hz), it tends to cause troublesome char formation and spark generation, particularly when treating calcium phosphate stones. These phenomena, explosive combustion and carbonization can reduce ablation efficiency and increase the risk of thermal damage and fiber degradation. Optimizing TFL settings is very important for outcome and safety and ongoing evaluation. AI in Medical Imaging – Converting 2D Black & White to 3D and Applications in Mixed Reality (MR) used in RIRS Artificial Intelligence (AI) and Extended Reality (XR) are at the forefront of innovation in modern medicine. In endoscopic surgery, these technologies are increasingly being integrated to enhance procedural precision and intraoperative guidance.
One experimental application involves using AI to convert 2D CT scans into 3D visualizations, offering surgeons a more intuitive understanding of anatomical structures. Devices like the Apple Vision Pro may be used to create fully immersive virtual environments, although it is not currently approved as a medical device.
In clinical practice, Mixed Reality (MR)—which blends real and virtual environments with real-time interaction—has shown promise. MR has been used during Retrograde Intrarenal Surgery (RIRS) to reduce the risk of missed stones, and in Endoscopic Combined Intrarenal Surgery (ECIRS) to overlay anatomical data, improving puncture accuracy during Percutaneous Nephrolithotomy (PCN).
As an emerging field, further advancements will depend on enhanced imaging resolution, improved intrarenal navigation and integration of AI-driven real-time stone detection.
-
Hsiang-Ying LeeTaiwan
Moderator
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
Yi-Yang LiuTaiwan
Speaker
Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required.
Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm.
Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs.
In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required.
ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
TICC - 3F Plenary Hall
|
|
15:30
17:00
|
Diversified Approaches to Stone Management
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Deok-Hyun HanKorea (Republic of)
Speaker
The Era of ECIRS: Prone Still Matters!Endoscopic combined intrarenal surgery (ECIRS) couples antegrade and retrograde endoscopy to raise stone-free rates while limiting morbidity. Although the Galdakao-modified supine position is widely used, surgeons experienced with prone percutaneous nephrolithotomy (PCNL) can realize distinct advantages when ECIRS is performed in the prone split-leg position. This lecture reviews practical operating-room setup and positioning—including feasible workarounds when a split-leg positioner is unavailable—monitor layout, and puncture trajectory planning. It details endoscope-guided puncture and coordinated intrarenal navigation, and highlights scenarios where prone ECIRS is particularly advantageous: posterior and upper-pole access, narrow calyces, complex collecting-system anatomy, and situations requiring stable distension and visualization. We discuss how prone positioning can improve irrigation dynamics, enable a “vacuum-cleaner” effect for fragment clearance, reduce thermal injury risk, and limit retrograde fragment migration—often without a ureteral access sheath. Strategies for comprehensive residual-fragment assessment and efficient D-J stent placement are outlined, along with trade-offs (airway considerations, workspace and monitor configuration, and the brief learning curve for retrograde orientation). In sum, prone ECIRS is a feasible, reproducible extension of prone PCNL that offers a natural transition path for prone PCNL surgeons and may improve stone-free outcomes in selected patients. Further prospective data and standardized workflows will refine its role.
-
Yi-Sheng TaiTaiwan
Moderator
Which Laser for RIRS: Thulium Fiber Laser Thulium Fiber Laser (TFL)is a type of fiber laser, distinct from Thulium laser used for prostate surgey. It’ a cutting-edge laser and rapidly gaining traction in urology The machine is compact, portable, quiet with air-cooling, and lower power consumption.It employs a thulium-doped silica fiber powered by diode lasers, emitting light at 1940 nm, matching water absorption peaks. This results in a high absorption coefficient and shallow penetration (~0.1 mm), enabling precise energy delivery and minimizing tissue damage.Compared to Holmium lasers, TFL operates at lower energies (down to 25mJ) and higher frequencies (up to 2000Hz) for delicate tissue ablation and fine stone dusting.
The most notable change is pulse modulationHo:YAG lasers has Spike-shaped pulses and indicate greater energy concentration, resulting in higher localized heating, uneven fragmentation, and increased retropulsion.TFL produces pulses with uniform energy distribution and lower peak power, resulting in consistent ablation with less retropulsion and fewer thermal spikes.Higher water absorption rapidly forms a vapor channel, enhancing ablation efficiency.
But, TFL is not as ideal in surgical scenarios. At settings of low pulse energy (0.2 J) and high frequency (100 Hz), it tends to cause troublesome char formation and spark generation, particularly when treating calcium phosphate stones. These phenomena, explosive combustion and carbonization can reduce ablation efficiency and increase the risk of thermal damage and fiber degradation. Optimizing TFL settings is very important for outcome and safety and ongoing evaluation. AI in Medical Imaging – Converting 2D Black & White to 3D and Applications in Mixed Reality (MR) used in RIRS Artificial Intelligence (AI) and Extended Reality (XR) are at the forefront of innovation in modern medicine. In endoscopic surgery, these technologies are increasingly being integrated to enhance procedural precision and intraoperative guidance.
One experimental application involves using AI to convert 2D CT scans into 3D visualizations, offering surgeons a more intuitive understanding of anatomical structures. Devices like the Apple Vision Pro may be used to create fully immersive virtual environments, although it is not currently approved as a medical device.
In clinical practice, Mixed Reality (MR)—which blends real and virtual environments with real-time interaction—has shown promise. MR has been used during Retrograde Intrarenal Surgery (RIRS) to reduce the risk of missed stones, and in Endoscopic Combined Intrarenal Surgery (ECIRS) to overlay anatomical data, improving puncture accuracy during Percutaneous Nephrolithotomy (PCN).
As an emerging field, further advancements will depend on enhanced imaging resolution, improved intrarenal navigation and integration of AI-driven real-time stone detection.
-
Hung-Yi ChenTaiwan
Speaker
How to Use Intrarenal Pressure Monitoring to Identify Risky Steps during RIRS Surgery, and the Function of FANS.Intrarenal pressure (IRP) elevation during retrograde intrarenal surgery (RIRS) is associated with increased risks of renal injury and infection. Real-time IRP monitoring enables identification of risky procedural steps—such as access sheath insertion, stone fragmentation, and basketing—where pressure spikes commonly occur. Recognizing these moments allows timely adjustments to irrigation and technique. The Flexible and Navigable Suction Ureteric Access Sheath (FANS) plays a key role in pressure management by facilitating continuous suction and efficient outflow, thereby reducing IRP and improving visibility. Incorporating both IRP monitoring and FANS enhances surgical safety and may improve patient outcomes in RIRS.
-
Yi-Yang LiuTaiwan
Speaker
Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required.
Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm.
Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs.
In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required.
ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
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Ching-Heng YenTaiwan
Speaker
What are the New Supportive Modalities in the Horizon to Increase the Efficacy of ESWL Extracorporeal shock wave lithotripsy (ESWL) has long been a standard non-invasive modality for managing urinary stones, yet its efficacy remains suboptimal in certain scenarios due to variable stone composition, size, and anatomical factors. Recent advancements have introduced several supportive modalities aimed at enhancing stone fragmentation and clearance. Among these, Burst Wave Lithotripsy (BWL) emerges as a promising technology utilizing focused, low-intensity ultrasound bursts to achieve finer stone fragmentation with greater precision and reduced tissue injury. In parallel, adjunctive approaches such as external physical vibration, ultrasonic propulsion, and optimized patient positioning are gaining traction. Pharmacologic aids including alpha-blockers and potassium citrate have also demonstrated improved stone passage rates post-ESWL. Furthermore, artificial intelligence–driven targeting and real-time imaging advances contribute to improved shock wave focusing and treatment personalization. This review explores the evolving landscape of supportive technologies, with a focus on BWL and its integration with existing ESWL protocols, potentially reshaping the future paradigm of non-invasive stone management.
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Hsiang-Ying LeeTaiwan
Speaker
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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Chinnakhet
Ketsuwan Thailand
Speaker
Intra Renal Pressure Defines Outcomes: Current EvidenceIntrarenal pressure (IRP) is a crucial physiological parameter during endourological interventions, as elevated IRP is closely linked to increased fluid absorption, intrarenal backflow, compromised renal perfusion, and postoperative complications. Experimental studies in animal models have consistently demonstrated a correlation between increased IRP and augmented irrigation fluid absorption, renal parenchymal backflow, and reductions in renal blood flow. Clinical studies have reported baseline IRP values ranging from 14 to 17 mmHg, with transient peristaltic peaks reaching up to 25 mmHg. Notably, IRP frequently surpassed 60 mmHg during endoscopic procedures, particularly when utilizing manual hand-pump irrigation or employing ureteral access sheaths (UAS) with smaller diameters. Significant risk factors identified for sustained elevations of IRP include non-prestented ureters, Asian ethnicity, and omission of UAS placement. Furthermore, elevated IRPs have demonstrated a direct association with infectious adverse events, notably postoperative sepsis. Randomized controlled trials have established that manual hand-pump irrigation generates substantially higher IRPs compared to pressurized irrigation bags. Additionally, serial manual irrigation boluses have been shown to produce prolonged IRP elevations, with maximum peaks exceeding 100 mmHg and durations surpassing 40 seconds. Collectively, both preclinical and clinical evidence underscores the necessity of meticulous intraoperative IRP management during endourological procedures. Strategic optimization of irrigation techniques and appropriate UAS selection are imperative to effectively maintain IRP within safe physiological limits, thereby minimizing the risk of complicationsRole of VR/AR/MR in Endourology and Urolithiasis Renal stone disease is a common urological condition affecting diverse patient populations. Percutaneous nephrolithotomy (PCNL) is widely recognized as the primary treatment for large or complex renal calculi, offering high stone-free rates with low complication profiles. Nevertheless, achieving accurate percutaneous renal access (PCA) remains technically challenging due to anatomical proximity to vital structures and insufficient hands-on training opportunities for urologists. Virtual reality (VR) simulators, such as the PERC Mentor and Uro Mentor, have demonstrated significant improvements in PCA proficiency, operative efficiency, and complication reduction, establishing their validity as effective training platforms. Additionally, mixed reality (MR) and 3D holographic technologies, exemplified by HoloLens, enhance surgical planning and procedural accuracy, particularly in calyceal targeting during PCNL. Recent nationwide training needs assessments have further advocated for the integration of these advanced simulation technologies into urological education curricula. Ultimately, systematic incorporation of VR and MR simulation into residency training holds substantial promise in bridging existing skill gaps, refining surgical competencies, and circumventing ethical concerns associated with traditional methods of surgical education.
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TICC - 2F 201DE
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