In Vitro Suction Comparison of 3 Flexible and Navigable Suction Ureteral Access Sheaths (FANS) of 2 Sizes using a 7.5Fr Single-Use Flexible Ureteroscope: An AUSET-EAU Endourology Collaboration
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Purpose The primary aim was to study the in-vitro suction performance of three different Flexible and Navigable Suction Ureteral Access Sheaths (FANS) of two sizes each. The secondary aim was to study the impact of digital occlusion versus thumb sliders on suction performance. Methods We used the 7.5Fr single-use Flexible Ureterorenoscope from Innovex Medical (US27F-12-EU). The six FANS used were: 10/12Fr and 11/13Fr Innovex 40cm FANS, ClearPetra 46cm FANS, and Reborn 40cm FANS. Time taken to suction 100ml saline was measured. To test efficiency of stone suction, 1000mm 3 of 1 to 2mm stones were distributed equally between the upper and lower poles of a kidney model. Results All three 11/13Fr FANS had suction rates three times faster than their 10/12Fr counterparts (p = 0.001 for all FANS), when digital occlusion was used. Innovex and Clearpetra FANS had faster suction rates than Reborn FANS when suctioning 100ml saline, for both 10/12Fr and 11/13Fr. For the Innovex FANS, there was no difference in suction rate when using the thumb slider or digital occlusion. However, Reborn FANS had slower suction rates when using the thumb slider compared to digital occlusion for both 10/12Fr and 11/13Fr sizes. Innovex FANS was the fastest in suctioning upper pole calculi, followed by Clearpetra FANS, and Reborn FANS the slowest for 10/12Fr (198s versus 237s versus 537s respectively, p < 0.001) and 11/13Fr (158s versus 174s versus 332s respectively, p < 0.001). 10/12Fr and 11/13Fr Reborn FANS were not able to reach the lower pole calculi. Between Clearpetra and Innovex, there was no significant difference in time taken to suction lower pole calculi. Conclusions Faster suction was achieved with 11/13Fr instead of 10/12Fr FANS. With digital occlusion, the Innovex and Clearpetra FANS both performed similarly better in their suction performance than the Reborn FANS.
