temperature with warm humidified gas. I am not sure that these findings are clinically significant enough to justify the added expense of the commercially available technologies. Jeffrey A. Cadeddu, MD

Re: A New Robot for Flexible Ureteroscopy: Development and Early Clinical Results (IDEAL Stage 1-2b) R. Saglam, A. Y. Muslumanoglu, Z. Tokatlı, T. Cas¸kurlu, K. Sarica, A. I_ Tas¸c¸i, B Erkurt, € er, A. S. Kabakci, G. Preminger, O. Traxer and J. J. Rassweiler E Su Departments of Urology, Medicana International Hospital and Ankara University Medical School Hospital, and Department of Bioengineering, Hacettepe University, Ankara and Departments of Urology, Bagcilar Training Hospital, Medeniyet University Hospital, Kartal Training Hospital, Bakırko¨y Training Hospital and Medipol University Medical School Hospital, Istanbul, Turkey, Division of Urologic Surgery, Duke University Medical Center, Durham, North  Pierre et Marie Curie, Ho ^ pital Tenon, Paris, France, and Departments of Urology, SLK Kliniken Heilbronn, Carolina, Department of Urology, Universite Heilbronn and University of Heidelberg, Heidelberg, Germany Eur Urol 2014; 66: 1092e1100.

Abstract for this article available at Editorial Comment: This study introduces the first commercially available robotic system for endoscopic surgery. The system can accommodate any commercially available ureteroscope that is positioned through a ureteral access sheath. The surgeon sits at a console and can manipulate the scope as well as laser fiber movements remotely. The system was used safely in 81 patients, with an average docking time of less than 1 minute. Of the patients 80% were stone-free at 3 months, with the remaining having “clinically insignificant residual fragments.” Retrospectively the surgeons reported significantly improved ergonomics, with less arm, elbow, wrist and hand stiffness or pain when using the robotic system. We need to see more objective prospective data collection, including possible advantages in decreased radiation exposure. I hope this article does not represent the beginning of another industry driven and unsupported marketing campaign for robotic endoscopic surgery. Jeffrey A. Cadeddu, MD

Suggested Reading Desai MM, Grover R, Aron M et al: Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol 2011; 186: 563.

Re: A new robot for flexible ureteroscopy: development and early clinical results (IDEAL Stage 1-2b).

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