Specialists commentator comments

Comments on this technology were invited from clinical experts working in the field. The comments received are individual opinions and do not represent NICE's view.

All 4 experts who provided responses were familiar with, or had used, this technology.

Level of innovation

Three experts thought that MIP‑M was only a variation of an existing technology but 1 felt it was a completely novel design because its miniaturised nephroscope and sheath and low-pressure uncoupled system result in a new way of removing renal stones. All experts said they were aware of other miniaturised systems which have a similar function as MIP‑M and 1 noted that the role of miniaturised PCNL is evolving so the exact size of the kidney stone for which it is appropriate is still unclear.

Potential patient impact

All experts thought that because the incision needed would be smaller with the MIP‑M there would be improved patient outcomes for both adults and children. The benefits listed included reduced bleeding that may result in less need for nephrostomy tube and stent insertion, less postoperative pain and subsequent treatment with analgesia, quicker recovery and shorter length of stay in hospitals. All experts said that people with smaller stones – particularly those ranging in size between 10 mm and 30 mm – would benefit from this device. There were also other groups of people that at least 1 or more expert said could benefit. These included people with recurrent stones who need multiple surgeries, those with stones that are not accessible by flexible ureteroscopy and children.

Potential system impact

None of the experts thought that using MIP‑M would change the care pathway or need additional or altered infrastructure. It was noted that stone fragmentation equipment must be available on-site and small enough to be compatible with MIP‑M and 1 expert claimed that surgeons may need to be trained in using the device. All experts agreed MIP‑M may be beneficial to the NHS if it leads to shorter stays in hospital, the ability to offer an alternative treatment to the more invasive standard PCNL treatments and potential reductions in consumable costs. However, 1 expert stated that the initial expense could deter some trusts from purchasing MIP‑M.

General comments

All experts agreed this device may benefit a large number of people who need PCNL treatment. But a full randomised controlled trial comparing MIP‑M to RIRS or PCNL in a large sample in the NHS is needed.