Zamenix and Robotic RIRS: A New Technology Worth Understanding

Roen Surgical held its inaugural Zamenix symposium in Jeju last week, bringing together about 50 urology specialists from major Korean centres - Seoul National University Hospital, Samsung Medical Center, Asan Medical Center - alongside clinicians from Indonesia. Physicians shared early clinical and real-world experience with the AI-assisted kidney stone surgery robot following its commercialisation in Korea.

This is a company-sponsored symposium, not a peer-reviewed trial. The data are early and the framing is promotional. But the underlying technology is worth understanding, because robotic RIRS is a direction the field is moving.

What Flexible Ureteroscopy Actually Requires

To understand why a robot for RIRS exists, start with what standard flexible ureteroscopy involves. The surgeon holds a handle attached to a deflectable scope that may be 60 to 70cm long, navigates to the renal pelvis, identifies the stone, and fires a laser while continuously adjusting scope position, deflection, and patient position - often for 30 to 60 minutes, sometimes longer. The handle is heavy. The movements are small and repetitive. The surgeon is wearing lead if fluoroscopy is being used. Ergonomic injury in urologists doing regular RIRS is a documented occupational hazard.

A robotic system removes the surgeon’s hands from the scope and replaces them with motorised control. The same movements are made, but through a console, with the scope position held by the robot between adjustments.

What Zamenix Does

The system is designed specifically for RIRS - not adapted from a general surgical robot. Based on what was presented at the symposium, the key features include motorised scope control, real-time AI assistance, and respiratory motion compensation.

That last one is the most technically interesting. During RIRS, the kidney moves with the patient’s breathing. A laser fibre aimed at a 1 to 2cm stone in a moving target is less accurate than one tracking a stationary target. Respiratory motion compensation - where the system accounts for kidney movement during the respiratory cycle - is a meaningful feature if it works as described.

Clinicians from Korea University Anam Hospital presented on these safety features. Yeungnam University Hospital reported that procedure times decreased as experience with the system accumulated, which suggests a measurable learning curve that shortens with use. Mandaya Royal Hospital in Indonesia shared experience from approximately 30 procedures.

What We Don’t Know

Quite a lot.

There are no published peer-reviewed stone-free rates comparing Zamenix to standard flexible ureteroscopy. Stone-free rate is the primary outcome that matters in stone surgery, and without a comparative dataset it’s impossible to say whether robotic RIRS outperforms, equals, or underperforms the standard approach.

We don’t have data on complication rates, radiation exposure, or how the system handles difficult anatomy such as lower pole stones, obstructed systems, or narrow infundibula.

We don’t know the regulatory status outside Korea. The device passed a Korean government-approved innovative medical technology assessment. CE mark and FDA clearance are separate processes. UK availability depends on MHRA registration post-CE, and cost-effectiveness data don’t exist yet.

The “AI-assisted” description in the product framing needs scrutiny when the peer-reviewed literature arrives. AI in surgical robotics can mean many things - from basic image processing to real-time decision support. What it actually does in Zamenix isn’t clear from the symposium reporting.

Why It’s Worth Knowing About

Robotic assistance in flexible ureteroscopy addresses a genuine problem. Ergonomics, tremor, and the physical demands of standard RIRS are real, and the consequences for surgeons doing high-volume stone work are documented. If a robotic system can match stone-free rates while reducing surgeon fatigue and injury risk, that’s a meaningful advance.

The respiratory motion compensation feature, if validated, could also improve accuracy for small stones or difficult calyceal locations where positional shift during laser firing matters.

Zamenix is currently in early commercial use in Korea and appears to be building an international adoption base. The next step is peer-reviewed comparative data. The symposium experience is a starting point - useful for knowing the technology exists and is being used, not for clinical adoption decisions.