"Gun-holding" surgical posture versus conventional surgical posture in flexible ureteroscopy: a prospective randomized study.

Introduction: The ergonomic aspects of retrograde intrarenal stone surgery (RIRS) remain underexplored, despite their crucial role in minimizing musculoskeletal strain among surgeons and enhancing procedural efficiency. This study introduces a novel "Gun-holding" surgical posture for RIRS, aiming to improve surgeons' physical well-being and extend their operative careers.

Materials and methods: From July 2023 to June 2024, a total of 60 patients were prospectively enrolled from an initial pool of 104 and were randomized into two groups: the "Gun-holding" surgical posture group (Group A, n = 30) and the conventional surgical posture group (Group B, n = 30). Patient demographics, clinical outcomes, ergonomic assessments, and torque analysis for surgeons were analyzed.

Results: Baseline characteristics and stone burden were comparable between the two groups. Torque analysis demonstrated a higher upper limb torque ratio in Group A compared to Group B. Ergonomic evaluation revealed a significant advantage for Group A (total score: 16.1 ± 4.1 vs. 22.4 ± 9.1, P = 0.001). Group A also had a significantly shorter mean hospitalization duration (1.7 ± 0.9 days vs. 2.9 ± 1.9 days, P = 0.003). Although the mean operative time for Group A was shorter (49.9 ± 26.1 min vs. 63.0 ± 40.4 min), this difference was not statistically significant (P = 0.139). No significant differences were observed in initial stone-free status (SFS), 3-month SFR, postoperative Day 1 hemoglobin drop, or overall complication rates.

Conclusion: The "Gun-holding" surgical posture is a feasible, efficient, and safe alternative for performing RIRS, offering significant ergonomic benefits to surgeons.