(UroToday.com) The Thursday morning plenary session at the 2024 World Congress of Endourology and Uro-Technology Conference in Seoul was presented by Dr. Jeremy Teoh on the rapidly evolving world of urologic robotics.
Evolution of the Da Vinci System
Dr. Teoh highlighted the impressive advancements in Da Vinci’s multi-port SI systems and introduced the new single-port robot system, which has already demonstrated excellent clinical outcomes. However, as with any innovation, there remains room for improvement, especially in cramped surgical spaces where mobility is a challenge.
One of the rising techniques to overcome this is SARA (Supine Anterior Retroperitoneal Access), which is gaining popularity among urologists. Dr. Teoh discussed its increasing application in robotic surgeries, explaining how surgeons can gain access by entering anteromedial to the ASIS to develop an extraperitoneal space before docking the robot. The audience was treated to a video of a retroperitoneal partial nephrectomy, in which the SARA technique enabled the surgeon to successfully remove a posterior lower pole tumor. The patient, notably, recovered rapidly, particularly in terms of bowel function.
Another groundbreaking approach discussed was the Single Port Perineal Approach for Robot-Assisted Radical Prostatectomy. With a U-shaped incision over the perineum, this approach is similar to the retzius-sparing method, offering excellent oncological outcomes and even the potential for lymph node dissection. He did caution that given the anatomical location of the procedure, surgeons must proceed cautiously to avoid rectal injury.
A “Boom” in Robotic Systems
Dr. Teoh then explored the emerging boom-type and module-based robotic systems currently revolutionizing surgical theaters across the globe. Among the boom-type systems were Avatera from Germany, Revo-I from Korea, and Hinatori from Japan. On the module-based side, the Hugo system from the US, Versius from the UK, and India’s SSI Mantra are creating waves for their modular and adaptable designs that promise enhanced flexibility and precision during surgery.
Disruptive Technologies on the Horizon
Disruptive technologies were also front and center in Dr. Teoh’s presentation. The Zamenix Robotic Flexible Ureteroscopy System by ROEN Surgical is already making waves due to its mobile and flexible nature, significantly reducing radiation exposure and surgeon fatigue. The system’s console allows seamless control of the device, laser, and basket, although further development is needed before it becomes widespread in clinical settings.
Another technological marvel on the horizon is Virtuoso’s Transurethral Robotic Surgery System, which offers surgeons improved control during complex transurethral procedures. Dr. Teoh pointed out that its intuitive control mimics traditional laparoscopy, making it more accessible for surgeons already familiar with robotic tools. Virtuoso’s system promises to be a game-changer in the excision of transurethral bladder tumors, particularly for en-bloc resections. The system may also hold potential for use in muscle-invasive bladder cancer, partial cystectomies, and even transurethral ureteric reimplantations.
What’s Next for Urologic Robotics?
Dr. Teoh concluded his session with a forward-looking perspective on the next steps in urologic robotics, celebrating urologists as true pioneers in this technological revolution. With groundbreaking innovations and new surgical techniques constantly emerging, the future of urologic robotics looks brighter than ever.
Presented by: TEOH Yuen Chun Jeremy, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery), Assistant Dean (External Affairs) and Associate Professor, Faculty of Medicine, The Chinese University of Hong Kong
Written by: Bruce Gao, MD, FRCSC, Endourology Fellow, Department of Urology, University of California Irvine, @b_gao on Twitter during the 2024 World Congress of Endourology and Uro-Technology (WCET) Annual Meeting, August 12 -16, 2024, Seoul, South Korea