軟式輸尿管鏡的使用及維修分析—奇美醫院五年經驗
何宣瑩 廖建華 沈坤宏
奇美醫學中心 外科部 泌尿科
Analysis of the Usage and Repair of Flexible Ureteroscope—5-Year Experience of Chi-Mei Hospital
Hsuan-Ying Ho, Alex Chien-Hwa Liao, Kun-Hung Shen
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
Purpose:
The frequency usage of flexible ureteroscopy has increased in the diagnosis and treatment of upper-tract disease in recent years. Flexible ureteroscope allows endoscopic access to the ureter and kidney. However, maintenance and repair of scopes may increase the total procedure expense.
Materials and Methods:
In Chi-Mei Hospital, we started using flexible ureteroscopes since 2009. Starting from January 2011, we have two Olympus flexible ureteroscopes URF-P5. Cases were performed by senior residents under the supervision of attending urologists. In this study, we prospectively recorded the use and damage from January 2011 to December 2015. The damages of ureteroscopes were inspected by the maintenance department from our hospital, then the repair performed by the original manufacturer.
Results:
January 2011 to December 2015, two flexible ureteroscopes were used in 379 surgeries. The usages each year were 44 times in 2011, 77 in 2012, 82 in 2013, 54 in 2014, and 112 times in 2015. A total of 10 reports of damage were recorded (2.64% of total uses). Seven major damages (1.85% of total uses) because of breakage of bending rubber from distal part required comprehensive repairs from the original manufacturer and replacement of distal segment. The major damage rates each year were 2.27% in 2011, 0% in 2012, 2.44% in 2013, 1.85% in 2014, and 0.89% in 2015.
Conclusion:
Flexible ureteroscopes are fragile instruments. As the usage of flexible ureteroscopes increase, there is a notably increasing expenses associated with instrument repair. In our 5-year experience, we find that with the improvements of familiarity with the device, we can decrease the risk of major damage, thus decrease the maintenance expenses and improve the ureteroscope durability.