Robotic Assisted Flexible Ureteroscopy in Covid-19 Positive Patient Using Thulium Fiber Laser: Case Report and Literature Review

Flexible Ureteroscopy (FURS) has become an integral aspect of the surgical armamentarium to treat intra-renal stones that are less than 2 cm in diameter. Despite the progress made with regards to the design of the flexible ureteroscopes, surgeons still need to work with suboptimal ergonomics, which may result in orthopedic complaints, which as a result lead to imperfect performance. Robotic- Assisted FURS with Avicenna Roboflex has provided significant improvement of ergonomics. The Super Pulse Thulium Fiber Laser (SPTFL) may be considered as a viable alternative to holmium laser in stone management. Coronavirus Disease- 19 (Covid-19) has been declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. As a result, many hospitals have been converted to dedicated facilities to manage the Covid-19 patients. Urinary stone disease represents a benign condition, but in non-negligible number of cases, it can lead to potential severe septic complications that could increase the burden on emergency services. Many surgical specialties including urology has made short pathways for patient flow to decrease the contact with the patients which in turn will decrease the possibility of transmission of Covid-19. The use of new technologies such as Avicenna Roboflex and thulium fiber laser in Covid-19 positive patients when performing flexible ureteroscopy can minimize direct contact with the patient, expedite the procedure, while protecting the staff from getting Covid-19 infection.