Dr. Roger Sur
speaker
102 appearances
1 recordings
1 series
first heard Oct 2024
last heard Oct 2024
Dr. Roger Sur’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
In fact, the term clinically insignificant residual fragment is actually a misnomer. To that end, one of our journals actually has adopted a new definition of stone-free. Let's say stone-free has three grades. Grade A, the highest grade, is there are no stones, hence the word stone-free. On a CT scale. Yeah. Based off a CT scan.
Grade B would be less than two millimeters and grade C is less than four millimeters. And you may ask, well, shouldn't it be stone free or not stone free? Again, I think this is an evolving thing going on here, but I will say that in that edge paper that I was quoting, we did notice that when we cohorted
Stones less than four millimeters versus stones greater than four millimeters, we noticed a doubling in complication rates. So the size of the stone, not only the presence of the stone, but how big of a stone you're leaving behind has even a more profound effect on what's going to happen to you as a patient.
Yeah. Or it's the end of the day, right? It's your sixth case. I'm sure those fragments are going to pass. They don't look as big as they seem.
Exactly. I'm sure just like you and probably every urologist out there that works with a trainee particularly the younger trainees, the first time they're doing ureteroscopy, they're like, I'm just curious, sir, why don't we just vacuum these pieces out? And for the past 10 years, every time they would say that, I was thinking, I know, we're working on it.
Because myself and Dr. Hleblian and Brian Eisner, We're all co-inventors of the current CVAC device. We were all at the same time period thinking of the same thing. And about 10 years ago, we all had this idea to create a vacuum or suction device. And that's kind of the genesis of one of the devices that exists out there.
And CVAC is not the only device, but that is the device that I'm most familiar with as someone that I've used. But I'd like to talk about the other devices as well, because CVAC is not the only one. But that's really how it all started about 10 years ago. And currently that device is now available in the United States. Can I talk more about the history or?
yeah i mean from idea to a product that's ostensibly you know approved by the fda to use in humans that's not like something that happens overnight it may take a decade yeah starting in a lab using pig kidneys putting sand in the kidneys and then putting an axis sheath up there and trying to suction it back out with the single with the syringe and different catheters that was all part of the evolution which looking back i still got pictures it was
It was fun at that time to think, hey, maybe this will work and see now where we're at. It's really brings me a lot of joy. So what happened is a company was eventually formed and they created the first steerable vacuum aspiration system, which is CVAC 1.0. There's now a 2.0 out there. The CVAC 1.0 was good, but it was done under fluoroscopy. There was no camera associated with it.
And about 2,000 cases were performed throughout the United States. There was in fact even a multi-institutional randomized controlled trial called the ASPIRE trial, which was performed to demonstrate its efficacy over just ureteroscopy and basketing, which in fact it did.
But I think a lot of the critics were, you know, gave the company feedback as to, look, you know, this is great, but I can't really see what I'm doing here. And wouldn't it be nice if we could see something? So their engineers went back to the drawing board and they came out with 2.0, which is an all-in-one system that actually replaces the ureter scope because it has...
A camera has constant irrigation, constant aspiration, the ability to break up stones with a laser, and even collect. It has a little canister attached to the scope. So as you're breaking up the stones and aspirating, you're looking at the canister just literally filling up with stones. So that's the current generation that we're using right now for CVEC, and that's where we're at with that.
Well, Brian Eisner and I, we would go to the lab at University of California, Irvine with the team and we used a live porcine models. And so we would perform the ureteroscopy, use the CVAC, and then pass a scope back up there to see what would happen with the hopes that, please, please, please don't let there be too much mucosal injury. And fortunately, we never really saw a lot of mucosal injury.
And even more fortunately, it didn't translate into clinical trauma. So again, in the RCT and in our use, anecdotally, it really is a safe device, but it just was not adequate enough because we couldn't see. We're using fluoroscopy. Even though it was steerable, we couldn't see it visually.
That remains a problem, actually, which is a whole other conversation with machine learning that I would love to talk to you about some of our ideas and some of the things that we're doing. But I think machine learning will solve some of those problems because we have not solved that problem. So you're on to the next set of problems.
So you're obviously a student enough to realize, even though you're an oncologist, you realize we haven't solved all the problems. There's so many more problems that we have to do, which... Which makes it fun to be in research. So you're right. Size is a problem. Obstruction is a problem. We had to figure that out. We had to make sure it was safe. Above all else, it had to be safe.
And then we had to overcome the obstacles that would occur like obstruction.
Yeah, with the 1.0, it was like that. With the 2.0 now, we were just literally as you're lasering, you see the fragments just coming across your screen, collecting to your little container attached to the scope. And then when you want to really turn on the suction, it has this spray, a very proprietary spray action that comes out from the scope.
It's different than just irrigation coming out of scope. There's multiple sprays coming off the scope that surround the stone and bring the stone back to the scope. And then it's got a seven French channel that you can evacuate large fragments through the scope.
It was initially homegrown. I had to learn the hard way, truthfully. I didn't realize that everything I do in the university is owned by the university. So that initial patent that George and I spent a couple thousand dollars on, that really wasn't very useful. That's a nice write-off for us. The university's like, no, you have to go through us. So we had to go through them.
Showing 21–40 of 102 · page 2 of 6
← Previous
Next →