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.
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And then once that was patented, we did a roadshow and tried to find some investors and got some initial seed funding for that. And then the company was formed.
Venture capitalist type funding is how it came from. It wasn't a government or anything. It was a venture capitalist funding. No SBIRs or anything like that? No. I did not go that route. I just went on the road trying to pitch it to investors or angel investors looking for someone that was interested. And I had some different people and finally stumbled upon someone that saw eye to eye and
they were very student actually the questions that they asked it was very impressive meeting these people they're not just business people they uh they know science so i was actually shocked by how you know how well they understood the science
Yep. Constant irrigation, constant aspiration or suction. And then if you want to turn it on to high power irrigation, you've got that spray that comes out. And then the high power suction where you really turn on the vacuum. So there's two levels to it, the aspiration and irrigation.
Well, the problem is the current retroscopes that are out there, the working channel is a channel that's shared for irrigation fluid coming in, the basket or the laser that you're using, some working device. And then if you want to do what you're describing, then you'd have to... temporarily stop the irrigation and then pull back, right? And you think that would work.
But two things we've learned is number one, the channel is not very big. 3.6 French is only 1.2 millimeters in diameter. So your stone bear be smaller than a millimeter, which is pretty small. And then two, kind of like a balloon or when you're emptying the bladder, you're e-licking the bladder.
If you don't have enough irrigation, the whole eclecticism collapses down onto the device, much like you're doing an e-lick and you have not put in enough irrigation into the bladder, right? You don't get anything back. It just collapses down onto your scope. So that's really the problem that we've discovered. Got to have a balance. Yeah.
And that's why having constant irrigation and constant aspiration is really, I believe, a game changer. Because it's kind of like having a continuous resectoscope. And imagine you had a resectoscope, but suddenly someone introduces, how about a continuous flow resectoscope? Not just...
A resectoscope where you have to kind of, you know, when you want to aspirate, you have to take apart the scope, which was the old scopes, right? Like, wow, yeah, we'll do both at the same time. And then we'll attach a little suction to the outflow so you really get some aspiration. So that's kind of the best analogy in my mind is what the CVAC device is like.
It's like a resectoscope, so to speak, in the ureter.
I would say currently on the market, there are three predominant devices that exist. The CVAC system, which uses the steerable uroscopic renal evacuation. We call it SURE. That's the name of the procedure, the CPT code that's associated with it. It's not just ureteroscopy. It's actually called steerable uroscopic renal evacuation. That's the code you use when you use the CVAC.
Now, there's two other devices that don't use that coating. There's the FANS, which is Flexible and Navigable Sheath, which uses basically, it's like ClearPetra is the big maker in the United States. It's actually a Chinese company, but that's probably the most common device that's used here in the United States. And then there's Direct In Suction Scope, DISC.
So those are the two other devices that exist right now that you can consider if you're not going to use a CVAC. And what fans is basically, it's an axis sheath, but it has a side port where they're actively aspirating. And you can actually regulate the amount of, not aspirating, but you're vacuuming. They attach a suction tubing to the side port. It's kind of like a Y coming off the axis sheath.
And you attach it to a suction tubing, which goes to the wall. And you can actually regulate the amount of suction. And the beauty of this device is axis sheaths are 10 French in inner diameter or 12 French, depending on how big of an axis sheath. So you can really remove large fragments. What you have to do is you break up the stone.
and then pull the scope back and use that kind of vortex phenomena. You've seen it. As you're pulling the scope back and the irrigation is going, the stone just follows the scope back. And of course, if you have a vacuum attached to the side port of that fan's device, then you're just sucking all these huge fragments out.
and they now have a 2.0 version where they found that, you know, just sticking access sheets up there, think about it, it's not very maneuverable, right? What if a stone's in the lower pole? Well, they recognize that and they iterated where they made the last 10 centimeters very flexible. So you can pass your scope into the lower pole
pass the axis sheet over the scope and now the the axis sheet is in the lower pole and then you can break up stones and remove the scope back and forth back and forth to remove large fragments and also while you're dusting there's also fragments coming around the scope as well down the axis there's there's two ways that the fans device removes stones small particles going around the ureter scope
and then large pieces coming down as you pull the entire ureteroscope back.
So imagine a ureteral axis sheath, but then at the portion where you put your scope in, there's actually a suction port that attaches to it, kind of like a Y. So it's coming at the same channel irrigation.
And that's how that functions. So the last one is the direct in-scope suction. This is kind of what you had kind of alluded to with your first question. Why can't you just take a scope and aspirate back with a syringe? And shouldn't that be good enough? Well, as I described, you know, you have to, it's one working channel.
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