The Development of the Collaboration for the Leap of Uro-Endoluminal Surgeries (CLUES), www.cluesurology.org

 

Among urological diseases, urolithiasis is one of the most commonly seen, along with prostate diseases. Stones may occur in the entire urinary tract region, including kidneys, ureters, bladder, and urethra. Even in the asymptomatic state, kidney stones often require treatment as they may increase in size, impair renal function, or cause emergencies by moving into the ureter. “Usefulness of flexible ureteroscopy in diagnosing and treating upper urinary tract disease” was first published in Korea by Professor Hyeon Hoe Kim and his team on October 13, 2001, at Seoul National University Hospital. However, even after publication, it was not possible to overcome the difficulties of the initial technique until the early 2010s in Korea, where there were less than 100 cases implemented across the country. At the time, Korea heavily relied on extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for kidney stones, and such techniques revealed their limitations in the treatment of intrarenal stones. Urologists tended to regard percutaneous nephrolithotomy as some big hospitals’ exclusive property.

 

Overseas, many studies that combine medical devices and new technologies had been conducted with urolithiasis as a separate specialized field. However, to this day, awareness in Korea is still somewhat lacking. Until early 2010, laparoscopy and robotic laparoscopy had been the main focus of development, rather than endoscopy. Existing societies could not keep up with the rapidly increasing demand for education on treatment and surgical methods for stone disease due to the constraints of the conference schedule and a lack of experts. This situation gave rise to an acute need to provide learning opportunities and spaces in which clinicians could share expertise and discuss kidney stones. Now, we have entered an era in which stone surgery has developed with a focus on hospitals and individuals. It became widely accepted that there was a need to establish a research group in an open space where researchers could constantly discuss and study better methods of stone surgery and patient treatment. On December 14, 2013, at the Gyeongin Conference, a paper on the learning curve and stable surgical procedure of flexible ureteroscopic surgery (Professor Sung Yong Cho, SMG-SNU Boramae Hospital), which was to be published in the Plos One journal, was introduced. Subsequently, a first meeting at the SMG-SNU Boramae Medical Center-Hallym University Medical Center (Professor Woojin Bang) on July 9, 2014, became the starting point for the Young Endourological Study (YES) group.

 

Firm in the belief that it is important for the entire medical team in the field, including nurses as well as surgeons, to be given opportunities to participate in surgery and improve the surgical environment, visits were made to specialists’ operating rooms to educate those who wished to perform endoscopic stone surgery professionally. Visits were made to Hallym University Medical Center (November 20, 2014), Dongtan Sacred Heart Hospital (December 18, 2015), St. Vincent's Hospital (March 25, 2016), Kangdong Sacred Heart Hospital (July 22, 2016), Konyang University Hospital (December 30, 2016), Kyung Hee University Hospital (February 13, 2017), Hanyang University Hospital (July 6, 2017), Yeungnam University Medical Center (October 13, 2017), SMG-SNU Boramae Medical Center (December 27, 2017), Gachon University Gil Medical Center (December 21, 2018), Keimyung University Hospital (July 19, 2019), Busan Adventist Hospital (October 25, 2019), Daegu Fatima Hospital (June 30, 2021), Gangnam Sacred Heart Hospital (November 12, 2021), to name but a handful, and operations were performed with operating surgeons and field nurses in attendance. Furthermore, the opportunity to observe the surgical site was provided to the fullest with leading experts conducting the surgery. Since then, as the group developed into the Collaboration for the Leap of Uro-Endoluminal Surgeries (CLUES), I would like to take this opportunity to remind you all that all the training courses to improve the level of stone surgery were made possible by the dedicated investments of experts who visited the actual sites.

 

As it has done up until now, by exchanging personnel and technology with other domestic societies, the CLUES group has been rapidly developing the field of endoscopic stone treatment in Korea. It has led the way with techniques such as flexible ureteroscopic surgery, miniaturized percutaneous nephrolithotomy, endoscopic stone surgery using ultrasound, ipsilateral or bilateral combined intrarenal surgery for complex renal and ureteral stones, and minimally invasive percutaneous nephrolithotomy in children. As it has led or participated in educational events of several domestic medical device companies, while adhering to the low-cost, high-efficiency on-site training and continuous discussion approach, the group has been asking the question: what is the most fundamental idea that we have forgotten regarding the field of urology and urolithiasis? These efforts saw it actively participate in the 1st Endoluminal & Technology Symposium (ETS) held on May 3–4, 2018. The group has been instrumental in helping Korean urologists play a leading role in Asia.

 

The opening of the website (www.cluesurology.org) demonstrated the determination of the new chairman, professor Dong Sup Lee, in sharing challenging cases of patients with stone surgery with domestic stone surgeons struggling with limited opportunities for exchange of knowledge in this field, as well as in further strengthening the opportunities for regular discussions. In the Book of Rites, the Xueji, or “Teaching and Learning promote each other” section of Liji, one of the Chinese Confucianism's Five Classics, has taught us that we can grow by teaching and learning from one another. Likewise, I believe this will be an opportunity for us to take a greater leap forward in the field of stone treatment in Korea, and I hope the group continues development and success.

 

January 6, 2022

Professor Sung Yong Cho,

Department of Urology, Seoul National University College of Medicine,

Seoul National University Hospital