Flexible URS: Available robotic platforms

Master’s console during the procedure and slave part during the docking of Roboflex Avicenna

Robotic platforms in endourology have significantly evolved since 2008 when Desai et al. introduced early applications of robotic flexible ureteroscopy.(1) The Roboflex Avicenna®, developed by ELMED and introduced in 2012, is now in its 5th generation, continuously enhancing ergonomics, haptic feedback, precision, and operational efficiency.(2) This platform features advanced joystick controls, improved visualization capabilities, reduced radiation exposure for surgeons, and increased flexibility in accessing challenging renal anatomical locations.(3) Roboflex Avicenna® has demonstrated consistent capability in standardizing complex intrarenal procedures, solidifying its role in global urological practice.

The ILY® robotic system, developed and introduced into the market in 2020, brought notable innovations such as a compact design and a wireless, joystick-operated controller [4]. These features significantly enhance surgical ergonomics, reduce radiation exposure to medical personnel, and provide precision and stability during procedures. The ILY system’s ergonomic enhancements are designed to reduce operator fatigue and offer greater operational accuracy, potentially minimizing procedural complications and improving patient outcomes.(4)

EasyUretero, developed by ROEN Surgical Inc. in 2022, specifically addresses intuitive handling and ergonomic considerations.(5) Its second-generation version, Zamenix®, introduced further refinements including an intuitive interface, increased operational speed, and improved procedural efficiency. Zamenix reduce procedural complexity and physical strain on surgeons, promoting broader adoption through better user interaction and enhanced operational effectiveness in managing urolithiasis.

The MONARCH® robotic platform was clinically introduced in 2022 by Johnson & Johnson MedTech, combining mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (URS). This advanced system employs electromagnetic guidance for precise renal access, robotic ureteroscopic control, and integrated aspiration capabilities.(6)

The integration of the Flexible Adjustable Navigation Sheath (FANS) into robotic platforms further enhances visualization quality and operational speed, allowing for more efficient stone clearance and improved procedural outcomes.

Future advancements in robotic endourology will likely emphasize flexibility adopting miniaturized scopes, integration of artificial intelligence, telesurgery, and improved tactile feedback, significantly enhancing surgical precision and accessibility. Advancements in computer vision and robotic automation seem to revolutionize ureteroscopy.(7,8)

Dr Tzevat Tefik

Istanbul Faculty of Medicine, Turkiye