Presentation Authors: Francis Jefferson*, John Sung, Courtney Cottone, Sherry Lu, Shlomi Tapiero, Roshan Patel, Peter Ghamarian, Ralph Clayman, Ramy Yaacoub, Jaime Landman, Orange, CA
Introduction: Consistent irrigation is essential in optimizing the endoscopic view during percutaneous nephrolithotomy. Operating room staff expend time and physical effort in maintaining manual hand pump irrigation in order to ensure irrigant flow. We sought to evaluate whether an automated irrigation pump (AIP) (ThermedxÂ® FluidSmartTM) improves procedural efficiency and nurse and surgeon satisfaction regarding irrigation during percutaneous nephrolithotomy.
Methods: Patients undergoing percutaneous nephrolithotomy for unilateral stone disease were randomized to hand pump or AIP irrigation; each system was set at 150-200 mmHg. A dedicated observer recorded the time that nurses spent preparing the irrigation system preoperatively and servicing the pump intraoperatively; the number of irrigation-related issues verbalized by the surgeon was recorded. Surgeons and nurses completed a postoperative survey assessing the quality of the irrigation system (1 = highly dissatisfied to 10 = highly satisfied).
Results: Twelve patients were randomized (6 AIP and 6 hand pump). Total time dedicated to the irrigation system and setup time were both statistically significantly less with AIP (Table 1). Intraoperatively, the circulating nurse spent 2.2% of their time maintaining the AIP compared to 19.2% of their time for the hand pump system (p = 0.02). Both surgeon and nurse satisfaction scores were higher when the AIP was used (10 vs. 6.3, p = 0.04 and 9.8 vs. 3.0, p < 0.001). Despite similar operative time, the AIP cases required half as much irrigant as the hand pump cases.
Conclusions: During percutaneous nephrolithotomy, utilization of an AIP was associated with enhanced surgeon and nurse satisfaction, a 50% decrease in liters of irrigation fluid used, and a more than 20-minute decrease in pump maintenance by the circulating nurse.