Preliminary Evaluation of High Frequency Jet Ventilation in RIRS from a Tertiary Center

Abstract

PurposeRetrograde intrarenal surgery (RIRS) is an effective and safe therapeutic option in the treatment of renal stones&upper tract urothelial carcinoma. High frequency jet ventilation (HFJV) is a lung ventilation mode offering a substantial reduction of renal movement. In our pilot study, we evaluated a HFJV ventilatory protocol in endoscopic treatment of renal stones.Materials and methods15 consecutive cases of the treatment of renal stones larger than 7mm have been included in our study, with exclusion of patients suffering from severe pulmonary disease. Total intravenous anesthesia has been chosen with intraprocedural HFJV. The intraoperative gas exchange parameters, as well as eventual postoperative respiratory adverse events were taken note of. A laser stone disintegration has been performed in all procedures, including a three-month postoperative follow-up.ResultsMean duration of HFJV procedure was 56,3 min (35-110), Et CO2(end tidal ; carbon dioxide concentration measured at the end of expiration,the normal values of which are 4-6%) before HFJV - 4,81 % (4,1-5,8) and after HFJV 5,22 % (3,9-7,2) respectively. No signs of respiratory impairment were detected. The operative time ranged between 20- 102 min. The renal movement reduction with HFJV was of significantly noticeable by the surgeon. Three patients were readmitted to the hospital; one of them due to a urinary tract infection. No perioperative pulmonary complications were reported. ConclusionHFJV is a safe, feasible method that can be used in RIRS and can significantly enhance the efficacy of the procedure. However, further evaluation of the method is needed.