URSL

Ureteroscopic Lithotripsy (URSL)

Quick Reference

Theatre setting

Apply to both left and right URS case (if Dr. Li KM on OT List):

RIGHT arm tucked

C-arm on patient's RIGHT side

TV and Xray monitor on patient's LEFT side

OT table: Add extension board (must)

OT table Slide down (must)

Equipment, Instrument & Scope

Equipments

-URO HDTV 3 / 5 (OT10)

-Laser machine

-Xray C arm

Instruments

-S203 Urology Basic

+/- S203A Cystoscopy, Adult

+/-Laser Probe 365

-Basin for 1L NS

+/-Basin for containing Laser probe

-URO Camera

-FOB

Scopes

-Semi-rigid URS (Compact) (prefer Fr 6/7.5)

+/- Cystoscope (UC21)

assembly of compact

1. Necessary accessories:

Yellow diaphragm x 1

Metal cap x 1

Red rubber nipple x 1

2. Assemble yellow diaphragm and metal cap

3. Assemble metal cap and yellow diaphragm with Compact

4. Put on red rubber nipple, then the Compact is ready to use

Consumables

-Drape: Lithotomy Pack + Large Drape

-Xylocaine Jelly

-0.035 Guidewire Straight

-20ml syringe x 2

-TURP set

+/- ½:½ Contrast

Draping

1. Underbuttock drape

2. Legs drape

3. Large drape for patient body

URSL steps

1. Connect camera head, FOB, NS tubing with the URS and White balance

2. Insertion of Guidewire through the URS and ureteral opening into the ureter (remember to perform 2nd timeout)

3. Confirm right ureter and stone by Xray

4. Guidewire will be left in the ureter and the URS will be taken out. Using the artery forceps (and guidewire sheath by Dr Li KM) to secure the guidewire on the leg drape. DO NOT directly clamp on the guidewire.

5. Lithotripsy by Laser as surgeon request

6. +/- Stone forceps to retrieve stone from ureter to bladder
(Choose stone forceps according to the "Stone Grasping Forceps Scenario" below)

7. Double J Stent insertion

important notes for laser

- Do Not directly clamp on the Laser fibre

- Before handing over to surgeon, make sure no ‘circle’ and no twisting of the fibre

stone grasping forceps scenario

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