Flexible ureteroscopy can be challenging, particularly due to poor visualisation and the delivery of safe calculi lithotripsy. The Clearpetra Flexible and Navigation Suction (FANS) Sheath is making major breakthroughs by providing improved visualisation of intrarenal anatomy via effective suction of debris and pus during operations and allowing the clearing of calculus dust and large fragments post-lithotripsy. Through this surgical video abstract, we are demonstrating the utility of FANS sheath in a few complex stone cases achieving effective stone clearance.

The demonstrated cases are performed by local urology department primary stone surgeon. Our local urology stone unit using set up as follow: 7.5Fr Urofino flexible ureteroscopy, Clearpetra FANS sheath, Lumenis Holmium lasering system, Endo flow Rocamed irrigation system. Clearpetra FANS sheath has a suction connection attached to the sieve bottle while joining into Neptune suction system.

We are showing two complex cases utilising the Clearpetra FANS sheath system:
Case 1 is a 75-year-old gentleman with infected left renal pelvis calculi who was stented prior to his definite flexible ureteroscopy and laser lithotripsy. Patient ureteroscopy revealed significant debris and pus occluding vision within the renal pelvis. By activating the suction system and advancing the sheath opening into the renal pelvis, the debris was easily and effectively cleared, thereby improving our vision. The flexibility of the sheath allows it to adapt to the angulation of the ureteroscope,, enabling safe deployment into the renal calyx as well. The suction power can be adjusted accordingly depending on the size of the debris required to be evacuated.

Case 2 is a lady with a significant stone burden of 4x1cm calculi in her left kidney. Once the calculi were fragmented and dusted. The FANS sheath also efficiently cleared the calculi dust and larger calculi fragments without requiring stone baskets and removal of ureteroscopy out of the sheath. These larger fragments were collected into filtering sieve bottle and will be sent for stone analysis.

Through these two cases, we have demonstrated Clearpetra FANS sheath has effective troubleshooting otherwise complex cases if using routine access sheath, in terms of clearing of intrarenal calculi dust and debris.