Presentation Authors: Joon Yau Leong*, Hong Truong, Seth Teplitsky, Brian Calio, Scott G. Hubosky, Demetrius H. Bagley, Philadelphia, PA
Introduction: Reusable ureteroscopy requires many expensive components which pose financial obstacles to centers in developing countries and domestic community centers. Lowering costs while maintaining operative quality during flexible ureteroscopy is an important goal. The Neoflex (Neoscope, USA) single-use flexible digital ureteroscope can connect to a video processing unit (VPU), which can connect directly to the standard OR monitor. It can also connect to a portable laptop adaptor device (PLAD), which produces HD videos on any Mac/Windows-based laptop and reduce much of the equipment cost. We perform an in vitro comparison of optics and performance between these two devices. Comparisons were also done with a Flex-X2 (Karl Storz, Germany) reusable fiberoptic ureteroscope.
Methods: For resolution, ureteroscope tips were positioned 10 to 50 mm away from a 1951 USAF test target at 10 mm increments. Data were analyzed per protocol, with higher numbers indicating better resolution. For contrast, ureteroscopes were moved down a 15 step grayscale gradient, starting from the darkest square to the lightest, until the observer noted a change in contrast between two squares. Color representation was assessed using a Macbeth Color Chart and graded on a scale of 1 to 3 (3 being the greatest similarity). Video recording of ureteroscopic laser lithotripsy with the VPU and PLAD were also shown to different urologists (n=10) for evaluation of image quality by questionnaire.
Results: There was no significant difference in resolution between the VPU and PLAD at varying distances (p=0.15). Color representation was slightly better in the VPU but contrast evaluation was similar in both devices (Table 1). Observers deemed illumination (p < 0.01) and overall performance (p=0.01) superior in the VPU, but comparable between both devices for glare, visualization, resolution and detail visibility (Table 2). When queried on their preferred device, 40% of respondents were indifferent to using either device. Both devices were superior to the fiberoptic ureteroscope in all 3 optical characteristics.
Conclusions: In addition to the PLAD being able to produce high quality images on standard laptop setups, both devices have the added potential to provide image quality comparable to that of expensive reusable ureteroscopy equipment, at a fraction of the cost.