New robot helps Israeli surgeons crush kidney stones without the splash

If you suffered from kidney stones in the 1980s and drinking a lot of water didn’t melt them, you probably were told by your doctor to get into a swimsuit and sit in a water-filled bathtub in the hospital. Then you were sedated or given general anesthesia.

A device called a lithotripter, developed in Germany four decades ago, sent shock waves efficiently through water into the body to pulverize stones comprised of crystallized uric acid, calcium oxalate, calcium phosphate, amino acid cystine, or magnesium ammonium phosphate.

Today, it is rarely used because small pieces were often left in the kidneys or ureters that caused clogs, and it didn’t work equally well on all stones. Newer lithotripters replaced the cumbersome water tank with small, targeted water-filled cushions or gel pads placed directly against the patient’s skin.

But now there is an even better method, and Israel is one of only about 11 countries around the world that have the new technology. Jerusalem’s Shaare Zedek Medical Center is the first in Israel to use the innovative ILY robot that crushes kidney stones using an interactive wireless remote control and a laser.

The system allows precise, stable robotic control of the uroscope so the surgeon can operate in a more comfortable and ergonomic position while maintaining full control of its movements within the urinary system.

The ILY robot system joins a series of cutting-edge technologies that the Shaare Zedek Medical Center’s urology department is using for the first time in Israel. Only recently, a system for treating an enlarged prostate based on artificial intelligence was put into use.

Kidney stones affect about 10% of the global population during their lifetime, but it varies according to regional, climatic, and demographic factors. In hot countries – as in the Middle East and in the tropics – the rate can be even higher, up to 20%, because of dehydration, so it’s recommended to drink a lot of water, especially in the heat.

Men are affected about twice as often as women, although the gender gap has been narrowing due to dietary and lifestyle shifts. There has even been an increase in kidney stone diagnoses among adolescents and young adults over recent decades that are closely tied to rising body mass index (BMI), as well as genetic diseases and diabetes.

The innovative technology is led by the director of the endourology unit (a urology subspecialty that uses small instruments and cameras passed through natural body channels to treat problems in the urinary tract), Dr. Ilan Kafka, who performed several successful surgeries using the robot a couple of weeks ago.

The procedure takes between 20 minutes and one-and-a-half hours, depending on the stone size and place in the kidneys and ureters.

The robot does not replace the surgeon, but rather provides him with a powerful and intuitive tool that brings an unprecedented level of control, stability, and ergonomics, he told The Jerusalem Post in an interview. 

“The combination of advanced control technology that is easily operated via a wireless remote control and our medical expertise allows us to perform complex surgeries with maximum safety, with maximum accuracy, and while maintaining the health of the team and the patient,” said Kafka.

Instead of holding the surgical instrument for a long time, the surgeon operates the robot remotely using an intuitive wireless remote control that gives the surgeon full control over the movement resolution of the flexible uroscopy.

It allows for gentle, precise, and stable navigation within the kidney while the urologist sits comfortably in a control position and reduces physical strain during prolonged surgeries, said Kafka, who studied medicine at Anahuac Mexico University in Mexico City, did his internship at the Rabin Medical Center in Petah Tikva, and is a member of the Israel Endo-Urology Association.

“It also minimizes the surgeon’s exposure to radiation, thanks to the possibility of controlling the system remotely and moving away from the radiation source when mirroring is used. It also reduced the need for a surgical incision,” he continued.

Kafka, who studied his subspecialty at the University of Pittsburgh Medical Center, went to a medical center in Portugal to practice on the ILY system, and quickly succeeded in using it efficiently: “It takes only about two procedures to get used to it.”

Bringing futuristic technologies to the operating room

So far, initial studies report high efficiency, high success rates, and safety in the treatment of kidney stones.

It was developed by the French technology company STERLAB in collaboration with leading research institutions.

Prof. Boris Tsertin, who heads the hospital’s urology department, added that “the introduction of the ILY system for the first clinical use in Israel constitutes another pillar of our excellence and ability to lead the forefront of medical innovation in the fields of urology, bring futuristic technologies to the operating rooms, and provide patients with the most advanced and safest medicine.”

The laser touches the stones – up to two or three centimeters wide, and not the tissue, so nothing in the body is affected besides the stone. The device is not autonomous; the surgeon is in control at all times, Kafka added.

Sometimes a stent is inserted to keep the ureter open and pulled out a few days later. If the patient has complicated anatomy, sometimes he or she has to be treated a second time. In any case, after the procedure, the patient is hospitalized overnight and then sent home. Recovery time, said Kafka, is very swift.

The success rate is 85%. Theoretically, it can be used on children, but they haven’t done any yet. However, it can be performed on people of any age, even 90 or 100. He expects that the unit will treat 800 or 900 patients a year, and it is paid for by health funds. 

“In the future, it might be possible to perform the procedure remotely without the surgeon being in the same room as the patient,” he concluded.