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Flexible ureteroscopes (fURS) are the most commonly used surgical device for endoscopic management of upper urinary tract conditions, including nephrolithiasis. Single-use flexible ureteroscopes (su-fURS) were introduced in 2015 with purported decrease maintenance costs and sterility concerns compared to reusable devices; however, the ergonomic impact of these devices on surgeons is not well-characterized. This study aims to investigate su-fURS ergonomics by developing a biomechanical feedback system for use during ureteroscopy. The study is designed for use by numerous su-fURS, with an initial focus on LithoVue™ (Boston Scientific). Two experimental models mimicking in-vivo fURS use were selected: an anatomically correct kidney-ureter-bladder (KUB) model; and a fURS training model simulating varying physical complexity and operator strain. Clinically relevant testing metrics selection was informed by fellowship-trained endourologist consultation. A series of representative fURS tasks was developed for testing: endoluminal navigation, kidney stone manipulation, basketing, and extraction. The dominant hand thumb, index finger distal interphalangeal joint, extensor digitorum tendons, and flexor digitorum muscle were identified as most relevant for monitoring and highest strain risk during fURS operation. A biomechanical feedback system was developed using a prototypical set of inertial measurement units provided by Mayo Clinic special purpose processor development group to provide live readings during endoscopic movements. Pilot testing demonstrated reliable hand kinematic measurements during simulated ureteroscopy. We developed and pilot-tested a novel biomechanical feedback system for flexible ureteroscopy to provide live feedback during ureteroscopy. Following further validation, this system may be applied to improve surgical training, decreasing physician fatigue and injury, and ultimately improve patient care.
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