Dr. Marcelino Rivera on the MONARCH platform for kidney stone removal

In this video, Marcelino E. Rivera, MD, highlights the MONARCH platform for minimally invasive, robotic-assisted kidney stone removal. The device is currently being studied in the STAR trial (NCT06330701), which is assessing the safety and efficacy of the device in patients undergoing robotic mini-percutaneous nephrolithotomy.

Rivera is an associate professor of urology at Indiana University School of Medicine and the director of the endourology fellowship at Indiana University Health in Indianapolis.

Video Transcript:

We're very fortunate [to be] working with Johnson & Johnson. We're 1 of the 2 clinical sites for this trial. The MONARCH is a robotic platform that has a couple of different modalities. There is a robotic ureteroscope that can be used for ureteroscopy that essentially uses a joystick. I actually have a model in my office. I could bring it in, but it's an Xbox––that's what it is. We use that to navigate with the ureteroscope into the kidney.

Then there's a second component, which is an access component. These are done with a supine positioning of the patient. They're rolled a little bit on their flank. Then the robot has something called a compact field generator, so basically, the ureteroscope has a little chip in it that can be detected by this field generator that sits above the patient. Then we can actually target the calyx for puncture, utilizing a needle that has a little chip in it that can localize to that area. So essentially, it can triangulate very, very accurately into the calyx. It's pretty slick. It's almost perfect each time in terms of a perfect papillary puncture. Every time we do a perc[utaneous nephrolithotomy], we want to be right in the middle of the papilla. That's where there's less bleeding. That's where there's less of a chance for having a complication. This technology is very slick in getting essentially right through the papilla each time. We did it today; it took about 2 minutes to get into the kidney. From there, the surgery becomes much more simplistic. You don't have to worry about bleeding. The visualization is very good.

Once we get our access, we can then use the third component of this system, [which is] a steerable suction catheter through the back. It has this snake-like catheter that has an opening in it, and it's on continuous suction. So, it can continuously suck the stone debris [and] the stone material out the flank while I laser it with the ureteroscope. Because it has flexible suction, I can steer it into each calyx independently of the ureteroscope. The way you do that is you toggle––just like you're playing a video game, you can toggle between, I don't even know, I don't play video games––but you can toggle between different things with the controller. So, you click a button and it goes to the ureteroscope. You click a button and it goes to the suction cap. You click a button and you can stick out a basket and grab stones. You click a button and you can put a laser fiber in. It's a pretty slick, very novel technology. Obviously, it's very unique, and so we're very fortunate to be able to be studying it and looking at patient outcomes, safety parameters, and stone free rates and other data that we're measuring in these patients. I think the future is very bright for endourology and pushing the envelope with different minimally invasive techniques to remove stones.

This transcription has been edited for clarity.