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We report the world's first case series of ten robot-assisted radical prostatectomy (RARP) procedures performed with the Dexter robotic system (Distalmotion SA, Épalinges, Switzerland). The Dexter system is an open robotic platform that integrates into the existing operating room (OR) equipment. The optional sterile environment for the surgeon console provides flexibility for transition between a robot-assisted surgical procedure and a traditional laparoscopic setup, allowing surgeons to selectively use their preferred laparoscopic devices for specific surgical maneuvers on-demand. Ten patients underwent RARP ± lymph node dissection at Saintes Hospital (Saintes, France). Positioning and docking of the system were quickly mastered by the OR team. All procedures were successfully completed, without any intraprocedural complication, conversion to open surgery, or major technical failure. The median operative time was 230 min (interquartile range [IQR] 226–235), and the median length of stay was 3 d (IQR 3–4). This case series demonstrates the safety and feasibility of RARP with the Dexter system and provides the first insights into what an on-demand robotics platform could offer to hospitals willing to start or expand their robotic surgery program. [ABSTRACT FROM AUTHOR]

The obturator nerve can be damaged during urological or gynecological surgeries. Obturator nerve injury is a preventable complication for which there are different management options, depending on the type of nerve injury. Obturator nerve injury (ONI) is an uncommon complication of pelvic surgery, usually reported in 0.2–5.7% of cases undergoing surgical treatment of urological and gynecological malignancies involving pelvic lymph node dissection (PLND). To describe how an ONI may occur during robotic pelvic surgery and the corresponding management strategies. We retrospectively analyzed video content on intraoperative ONI provided by robotic surgeons from high-volume centers. ONI was identified during PLND and managed according to the type of nerve injury. The management approach varies with the type of injury. Crush injury frequently occurs at an advanced stage of PLND. For a crush injury to the obturator nerve caused by a clip, management only requires its safe removal. Three situations can occur if the nerve is transected: (1) transection with feasible approximation and tension-free nerve anastomosis; (2) transection with challenging approximation requiring certain strategies for proper nerve anastomosis; and (3) transection with a hidden proximal nerve ending that may initially appear intact, but is clearly injured when revealed by further dissection. Each case has different management strategies with a common aim of prompt repair of the anatomic disruption to restore proper nerve conduction. ONI is a preventable complication that requires proper identification of the anatomy and high-risk areas when performing pelvic lymph node dissection. Prompt intraoperative recognition and repair using the management strategies described offer patients the best chance of recovery without sequelae. We describe the different ways in which the obturator nerve in the pelvic area can be damaged during urological or gynecological surgeries. This is a preventable complication and we describe how it can be avoided and different management options, depending on the type of nerve injury. [ABSTRACT FROM AUTHOR]

The future of robotics relies heavily on the ongoing synergy between robotic surgery and artificial intelligence. To unlock their full potential, we should address issues such as accessibility, education, data privacy, and ethics. [ABSTRACT FROM AUTHOR]

The application of robot-assisted laparoscopic telesurgery for radical nephrectomy is feasible and safe. Telesurgery has much potential for development in urology. The demand for telesurgery is rising rapidly, but robust evidence regarding the feasibility of its application in urology is still rare. From March to October 2021, a surgeon-controlled surgical robot in a tertiary hospital in Qingdao was used to remotely conduct robot-assisted laparoscopic radical nephrectomy (RN) in 29 patients located in eight primary hospitals. The median round-trip delay was 26 ms (interquartile range [IQR] 5) and the median distance between the primary hospital and the surgeon was 187 km (IQR 57). Both the master unit and the slave unit were guaranteed by network and mechanical engineers, and surgical assistants were well prepared on the patient side to prevent complications. The primary evaluation metric was the success rate, defined as the percentage of patients who underwent successful remote RN without conversion to other surgical procedures and no major intraoperative or postoperative complications. The results demonstrate that the combination of 5G technology and surgical robots is a novel potential telemedicine-based therapy choice for renal tumors. Our study shows that telesurgery using 5G technology is a safe and feasible treatment option for patients with kidney tumors. The total delay between the remote location and the operating rooms where surgery was being performed was just 200 ms. This approach could reduce health care costs and improve the quality of medical services accessed by patients. [ABSTRACT FROM AUTHOR]

We describe the first five robot-assisted radical prostatectomies (RARPs) performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA) in Europe. The five patients underwent RARP ± lymph node dissection at OLV Hospital (Aalst, Belgium). All procedures were completed, with no need for conversion or for placement of additional ports. No intraoperative complication or technical failure of the system was recorded. The median operative time was 170 min (interquartile range [IQR]: 140–180) and the median console time was 120 min (IQR: 110–150). Median length of stay was 3 d (IQR: 2–4). System start-up and docking of the robotic arms were straightforward and rapid processes for a properly trained surgical team. Awaiting future investigations in larger series, this study proves the safety and feasibility of RARP with the Hugo RAS system and provides relevant data that may be of help to early adopters of this surgical platform. [ABSTRACT FROM AUTHOR]

Precision prostatectomy is a new form of focal therapy that appears to be safe and efficacious, and adds to the growing armamentarium of risk-adapted therapies for treatment of localized prostate cancer that avoid the functional side effects of whole-gland treatments. The existing treatment options for men with intermediate- or high-volume low-risk prostate cancer (PCa) are associated with a substantial risk of over- or undertreatment. The development of risk-adjusted therapies is an unmet need for these patients. To describe our novel technique of precision prostatectomy, a form of surgical focal therapy that allows radical excision of the index PCa lesion along with >90% prostatic tissue extirpation while preserving the prostatic capsule and seminal vesicle/vas deferens complex on the side contralateral to the dominant cancer lesion, and to report on medium-term functional and oncologic outcomes in the first 88 consecutive men who underwent this procedure between December 2016 and January 2020. Men with (1) prostate-specific antigen (PSA) ≤20 ng/ml, (2) clinical T stage ≤cT2, (3) a dominant unilateral lesion with Gleason ≤ 4 + 3 disease with any number or percentage of cores involved ipsilaterally on prostate biopsy, (4) no primary Gleason ≥4 lesion contralaterally, and (5) a preoperative Sexual Health Inventory of Men (SHIM) score of ≥17 (out of 25) with/without phosphodiesterase type-5 inhibitor use who consented to undergo precision prostatectomy were included in this single-arm, single-center, IDEAL stage 2b prospective development study. Robotic precision prostatectomy. The safety and urinary, sexual, and oncologic outcomes of the precision prostatectomy technique were studied. Descriptive statistics and Kaplan-Meier analyses were used to assess 12-mo urinary continence (0–1 pad), 12-mo sexual potency (SHIM score ≥17), 36-mo freedom from clinically significant PCa (grade group ≥2), secondary treatments, metastatic disease, and mortality. At study entry, the median age, PSA, and SHIM score were 60.0 yr (interquartile range [IQR] 54.2–65.9), 5.7 ng/ml (IQR 4.2–7.1), and 22 points (IQR 19–24), respectively. The median follow-up was 25 mo (IQR 14–38). At 12 mo, all patients were continent (0–1 pads), with 90.9% of patients using 0 pads. The median time to urinary continence was 1 mo (IQR 1–4). At 12 mo, 85% of all-comers and 90.2% of the preoperatively potent men were potent. The median time to sexual potency was 4 mo (IQR 4–12). From an oncologic standpoint, at 36 mo an estimated 93.4% of the patients were free from clinically significant residual PCa and 91.7% had not undergone any additional treatment. All patients were alive and free of metastatic disease at 36 mo. Precision prostatectomy is technically safe and reproducible and offers excellent postoperative functional results. At 36-mo follow-up, the oncologic outcomes and secondary treatment rates appear to be superior to existing ablative focal therapy results. Pending long-term data, a risk-stratified surgical approach to PCa may avoid whole-gland therapy and preserve functional quality of life in men with localized PCa. Precision prostatectomy is a new form of focal therapy for intermediate-risk prostate cancer in which a 5–10-mm rim of prostate capsule is left on the opposite side of the gland to where the dominant cancer is located. The technique appears to be safe and efficacious and adds to the growing armamentarium of risk-adapted therapies for treatment of localized prostate cancer that avoid the adverse effects on urinary and erectile function of whole-gland treatments. [ABSTRACT FROM AUTHOR]