As flexible ureteroscopy expands its role in treating urinary stones, clinical efforts are intensifying to enhance surgical precision by integrating robotic systems and suction technology. Recent initial clinical outcomes from a robotic flexible ureteroscopy procedure, conducted at an outpatient clinic in Korea, were presented and shared at a major academic conference.
Dr. Min-seung Ki of Goldman Urology Clinic, Jamsil branch, presented a collaborative study on his experience with robotic flexible ureteroscopy for urinary stone treatment at the ‘2026 KSER Academic Festival’ held in BEXCO, Busan, this past July. He also chaired an international session titled ‘The Era of Suction-Assisted Stone Surgery,’ which focused on suction-assisted stone surgery.
During the festival, clinical results for the Zamenix robotic flexible ureteroscopy system, a joint research effort by Dr. Na Joon-chae and Dr. Min-seung Ki of Goldman Urology Clinic, were unveiled. This study, previously introduced by Dr. Na Joon-chae last month, retrospectively analyzed 18 cases of upper urinary tract stone surgeries performed using Zamenix from October 2025 to May 2026. The cohort included challenging cases with large stones exceeding 20mm and multiple stones.
Two cases in the study required a conversion from the robotic system to a conventional manual flexible ureteroscope. One instance involved difficulty accessing a stone in the kidney’s lower pole, while another necessitated fine tactile feedback after incising a narrow calyx neck to enter the target calyx, leading to the choice of manual operation. These instances highlight not only the applicability of robotic systems but also current technological limitations and the critical importance of patient selection.
This suggests that while robotic control aids stable endoscope movement and laser manipulation, the surgeon’s experience and the use of conventional manual endoscopes remain crucial in anatomically challenging situations or when delicate tactile judgment is required.
Conversely, cases where the robotic system’s features were leveraged to overcome difficulties with conventional approaches were also reported. For a hard-to-reach stone located in the kidney’s lower pole, the robotic system successfully accessed it using the ‘Scope Inversion Technique,’ which changes the endoscope’s direction. For large impacted stones, robotic control was combined with the suction-assisted FANS technology.
The researchers identified stable endoscope control, precise laser targeting, and reduced physical burden on medical staff during prolonged operations as key advantages of robotic flexible ureteroscopy in real clinical practice.
This study is significant as it demonstrates the potential for robotic ureteroscopy to be applied in actual urinary stone surgeries, even in outpatient clinics, while simultaneously indicating that manual endoscope conversion or additional treatments may be necessary depending on anatomical structures. What does this mean for patients considering robotic surgery? It means that while the technology offers significant advantages, a tailored approach is often best.
Dr. Min-seung Ki commented, “While robotic flexible ureteroscopy showed promise in terms of stable scope control and precise manipulation, it is crucial to select patients carefully, considering stone size, number, location, and the kidney’s internal anatomical structure, rather than expecting identical results for all stones.” He added, “Further verification of appropriate candidates and cost-effectiveness based on a larger number of cases will be necessary in the future.”
Beyond his research participation, Dr. Min-seung Ki also chaired the ‘RIRS with FANS: All About It’ session at the kidney stone endoscopy surgery workshop during the academic festival. Here, he shared practical surgical techniques and application strategies for RIRS utilizing FANS, leading academic discussions on the latest endoscopic surgical methods for stones.