New Frontiers in Suction and Stone Removal

Suction technology has already transformed the treatment landscape for kidney stones, but do the next several years look like for the subspecialty?

In this video, the final installment in a 5-part series on suction technology in kidney stone treatment, Karen L. Stern, MD, and Naeem Bhojani, MD, FRCSC, explore the rapid evolution of suction-based stone surgery and look ahead to what emerging technologies may soon transform the field. Both experts agree that current systems such as the flexible and navigable ureteric access sheath, direct in-scope suction, and CVAC 2.0 have advanced ureteroscopy significantly, but they also believe these platforms are transitional. They anticipate a new generation of devices that will combine the strengths of existing systems while overcoming their limitations. Novel suction concepts, including approaches under development by early-stage companies, may further disrupt current practice by offering new ways to capture fragments, regulate pressure, and streamline the procedure.

Laser technology is also expected to play a major role in the next wave of innovation. Faster, more efficient dusting could reduce the need for repeated scope withdrawal and minimize the bottlenecks that occur during fragment evacuation. With improved energy delivery, surgeons may be able to remain in a suction sheath for longer periods, allowing debris to clear continuously around the scope rather than requiring repeated repositioning.

Safety remains a core theme, particularly regarding intrarenal pressure. The conversation highlights the importance of maintaining an optimal diameter difference—ideally about 1.5 Fr—between the scope and the sheath to preserve fluid dynamics and prevent pressure build-up. Stern and Bhojani stress that suction does not eliminate pressure risk, as clogging, lower-pole work, or dust accumulation can still cause elevations. Stepping out periodically to clear debris is essential for maintaining safe conditions.

The discussion extends to the performance of various suction sheaths, including differences in tip rigidity, efficiency of fragment retrieval, and potential for tissue trauma. The experts note that each design has trade-offs, and more comparative research is needed.

The segment concludes with practical advice for clinicians: avoid getting overwhelmed by the expanding number of devices. Instead, choose one available technology, master its nuances, and build expertise. Stern and Bhojani emphasize that all modern suction platforms outperform traditional ureteroscopy, and adopting any of them can meaningfully improve outcomes and surgical experience.