Access Sheath Use in Ureteroscopies
Access sheaths are often used in ureteroscopies where a scope may be introduced and removed multiple times during the procedure.
While there are a variety of sheaths and scopes available (see fig.3), it is generally accepted that smaller sizes of sheaths and scopes are preferable when possible. There are also choices to be made between standard fiber optic scopes, digital scopes, and disposable digital scopes. Standard fiber optic ureteroscopes are readily available in most hospitals. In recent times, however, digital ureteroscopes have become increasingly popular due to their superior optical qualities.
As of this writing, the smallest outer diameter access sheath available is the Cook Medical 9.5/11.5 fr., with the Richard Wolf Boa being the only high-definition digital scope on the market that can pass through it. The Boa has an 8.7 Fr diameter, 6.6 Fr distal tip, and a 3.6 Fr working channel. With clear optics and reduced dilation of the ureter, the Boa accomplishes a less invasive way of getting access to the kidney. The enhanced optics allows a surgeon to better focus on all intricacies of ureteroscopy. Although there are other ureteroscopes that accommodate the Cook 9.5/11.5 access sheath, those are not high-definition scopes.
To summarize, the Richard Wolf Boa offers a two-part advantage:
- The Boa’s enhanced optics makes it a superior choice over any fiber optic ureteroscope.
- While offering superior optics, the Boa is still capable of fitting through tight ureters and access sheaths.
If you are looking for a scope that can fit through the smallest access sheaths while not compromising image quality, look no further than the Richard Wolf Boa.
References
Sener et al. (2015, September). (PDF) can we provide low intrarenal pressures with good ... Retrieved October 18, 2021, from https://www.researchgate.net/publication/282044057_Can_We_Provide_Low_Intrarenal_Pressures_with_Good_Irrigation_Flow_by_Decreasing_the_Size_of_Ureteral_Access_Sheaths.
Medworks would like to thank David Rawls for this contribution to this article.