Robotic-assisted mini-percutaneous nephrolithotomy (PCNL) represents a novel and promising approach to renal stone management. This study details the first clinical experience using the MONARCH™ Platform (Ethicon, Redwood City, CA) at the University of California, Irvine, encompassing 13 patients undergoing robotic-assisted PCNL for renal calculi. The procedure integrates robotic ureteroscopic visualization and lithotripsy, a flexible robotic suction catheter for stone immobilization and extraction, and electromagnetically (EM) guided percutaneous access. All procedures were performed in a modified supine position, with an 18 Fr sheath facilitating access and a 15 Fr steerable suction catheter for stone removal. Post-operative outcomes were assessed on day 30 with CT scans to categorize residual stone burden as stone-free (Grade A), minimal fragments (<2 mm, Grade B), or small remnants (2.1–4 mm, Grade C).
The study reported a 92.3% procedural success rate, with only one case requiring manual completion due to robotic failure. Median patient age was 65 years, and the average BMI was 26.9 kg/m². Operative time ranged from 83 to 383 minutes. Notably, percutaneous access was achieved in a single pass through the papilla in all cases, and stones were removed through a single tract without requiring nephrostomy tubes. Post-operative day 30 results showed a significant reduction in stone burden (73%-100%), with 35.7% achieving complete stone clearance (Grade A). Complications were minimal, with two cases of minor injuries (UTI and ureteral wall injury) and one Grade 2 Clavien-Dindo complication. Importantly, no robotic device-related adverse events were observed.
This first-in-human study demonstrates the safety, efficacy, and feasibility of robotic-assisted mini-PCNL across diverse clinical scenarios, highlighting its potential to revolutionize minimally invasive stone management.
