Evolution and current applications of endoscopic combined intrarenal surgery: a scoping review from back to the future.

PURPOSE OF REVIEW: To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal surgery (ECIRS) for ureteral and kidney stones.

RECENT FINDINGS: The literature search was performed on 18th January 2023 using PubMed, EMBASE and Scopus. 35 studies were included. Among them, six were reviews. Since its introduction in 2008, ECIRS has evolved and improved. ECIRS can be performed in different patient position, such as modified supine Valdivia position by Galdakao, prone position with split-leg and supine position with good outcomes. Instrument miniaturization has also been introduced in ECIRS making it doable in an ambulatory setting. ECIRS showed shorter operative time, lower complication rate, and retreatment compared with conventional PCNL. Operative outcomes of mini-ECIRS are better than mini-PCNL alone. ECIRS also showed good outcomes in impacted upper ureteric stones. Recently, some studies have explored the robotic-assisted kidney puncture in ECIRS that avoided multitrack surgery, especially in anomalous kidney and staghorn stones.

SUMMARY: ECIRS is ready for primetime in endourology and can be considered the next gold-standard for a personalized stone approach in complex kidney stones.