Flexible and Navigable Suction Ureteral Access Sheath (FANS) marks a new era in retrograde intrerenal surgery (RIRS) especially in pediatric patients. Recent researches have shown that fans-UAS improves surgical performance by increasing stone-free rates and lessen complications.
The flexible and navigable design of dura allows for better access and thus increases stone fragmentation efficiency. Similarly, the suction function prevents blood from obscuring the clarity of the surgical field, the most important part of the RIRS. Knowing when specific scenarios apply to FANS-RIRS helps in understanding its advantages and applications better.
In this blog we will explore when is FANS RIRS used?
What conditions are treated by FANS RIRS?
Flexible and Navigable Suction Ureteral Access Sheath (FANS) in Retrograde Intrarenal Surgery (RIRS) is a tactic that strives to improve the management of an array of renal disorders. The cutting-edge technique comes with its applications which are:
1. Large Renal Stones (2-6 cms)
FANS RIRS works exceptionally well for large kidney stones. The built-in suction allows the stone fragments to be removed while the stone is being blasted into pieces within the sheath, which increases the stone-free rates after surgery.
2. Complex Stone Locations
Stones located deep in the poles of kidneys are sometimes very hard to reach. These complex places can be treated more efficiently because of the improved maneuverability that FANS brings with its flexible design.
3. Pediatric Urolithiasis
FANS RIRS is an emerging technique that has been found to be feasible and safe with favorable outcomes and low complication rates in the young patients. Children are smaller than adults, so this is a welcome change with which FANS can adapt to the anatomical structures.
4. High Stone Burden
FANS RIRS is very useful for patients with multiple or staghorn calculi stones. This technique eliminates the need for a clear surgical field, so many stones can be removed in a single session using suction.
5. Patients with Contraindications for Percutaneous Nephrolithotomy (PCNL)
As an alternative to PCNL for individuals with bleeding diathesis or associated morbidities, FANS RIRS provide a lower incidence invasive intervention.
By considering these specific conditions, FANS RIRS safes elders in need of a more complex approach to renal stone management.
What are the benefits of FANS RIRS?
Flexible and Navigable Suction Ureteral Access Sheath (FANS) enhances Retrograde Intrarenal Surgery (RIRS) by offering several key benefits:
1. Enhanced Stone Clearance
The suction mechanism of FANS effectively removes stone fragments and dust during the procedure, leading to higher stone-free rates. This immediate removal reduces the likelihood of residual fragments that could cause recurrence.
2. Reduced Intrarenal Pressure (IRP)
FANS helps maintain lower intrarenal pressure by facilitating continuous outflow of irrigation fluid and stone debris. This pressure management minimizes the risk of complications such as postoperative fever and urosepsis.
3. Minimized Stone Retropulsion
The design of FANS reduces the retropulsion of stones during laser lithotripsy, preventing fragments from moving to inaccessible areas and ensuring more efficient stone fragmentation and removal.
4. Shortened Procedure Time
By combining stone fragmentation and suction, FANS streamlines the RIRS process, potentially reducing operative time. This efficiency decreases anesthesia duration and enhances overall surgical safety.
5. Improved Surgical Outcomes
Studies indicate that FANS outperforms traditional ureteral access sheaths, offering better stone-free rates and fewer complications, thereby improving patient outcomes.
In summary, FANS significantly enhances the efficacy and safety of RIRS by improving stone clearance, reducing intrarenal pressure, minimizing stone retropulsion, shortening procedure times, and leading to better surgical outcomes.
How is FANS RIRS performed?
This advanced technique improves stone clearance and reduces intrarenal pressure, leading to better surgical outcomes.
Procedure Overview:
- Anesthesia and Patient Positioning:
- The patient is administered general anesthesia to ensure comfort and immobility during the procedure.
- They are positioned in the lithotomy position, which provides optimal access to the urinary tract.
- Ureteral Access:
- A flexible ureteroscope is carefully inserted through the urethra, passing sequentially through the bladder and ureter to reach the kidney’s collecting system.
- Introduction of FANS:
- The FANS device is introduced over the ureteroscope into the ureter.
- Its flexible and navigable design allows it to adapt to the urinary tract’s anatomy, minimizing trauma.
- Stone Visualization and Fragmentation:
- The ureteroscope provides real-time imaging, enabling precise identification of kidney stones.
- Laser lithotripsy is employed to fragment the stones into smaller pieces suitable for removal.
- Suction and Stone Removal:
- The integrated suction mechanism of FANS is activated to continuously remove stone fragments and irrigation fluid.
- This continuous suction helps maintain a clear surgical field and reduces intrarenal pressure, minimizing the risk of complications.
- Completion of Procedure:
- After confirming the removal of all significant stone fragments, the instruments are carefully withdrawn.
- A ureteral stent may be placed to ensure proper drainage and facilitate healing.
Postoperative Care:
- Patients are typically monitored for a short period and can often be discharged within 24 hours, depending on their recovery and absence of complications.
- Follow-up imaging, such as a low-dose non-contrast CT scan, is performed within 30 days to assess for any residual fragments and confirm the success of the procedure.
The integration of FANS into RIRS represents a significant advancement in the management of kidney stones, offering a minimally invasive approach with improved efficacy and safety profiles.
Expert Urologist Dr. Deepanshu Gupta
Dr. Deepanshu Gupta is a distinguished urologist and andrologist based in Gurgaon, India, with over a decade of experience in endourology, andrology, and renal transplantation. He has performed more than 8,000 successful Retrograde Intrarenal Surgeries (RIRS), achieving some of the fastest procedures with the highest clearance rates in the country.
Dr. Gupta’s expertise extends to penile implant surgeries, kidney stone management, and the treatment of various urological conditions, making him a leading figure in his field.
In addition to his surgical accomplishments, Dr. Gupta is committed to patient education and the advancement of urological practices. He actively engages with the medical community and the public through platforms like Instagram, where he shares insights and updates related to urology and patient care.
His dedication to excellence and patient-centered approach have earned him recognition as one of India’s foremost urologists, continually contributing to the improvement of urological health care services. Book a consultation today!