What’s New in Robotic Surgery? "Presentation" - Ronney Abaza
November 19, 2024
At the 2024 LUGPA annual meeting, Ronney Abaza presents an overview of innovations in robotic urologic surgery, discussing the evolution from the Da Vinci SP to the Da Vinci 5 with haptic feedback. Dr. Abaza also highlights emerging technologies including endoluminal robots for ureteroscopy, PSMA fluorescence imaging, augmented reality capabilities, and the future potential of AI integration in surgical robotics.
Biographies:
Ronney Abaza, MD, FACS, Central Ohio Urology Group, US Urology Partners, Mount Carmel Health System, Prostate Cancer Program, Dublin, OH
Biographies:
Ronney Abaza, MD, FACS, Central Ohio Urology Group, US Urology Partners, Mount Carmel Health System, Prostate Cancer Program, Dublin, OH
Read the Full Video Transcript
Ronney Abaza: This is Dr. Ronney Abaza, and I'm so happy to be with you to share with you what's new in robotic surgery. These are my disclosures, and I also want to acknowledge Dr. Duke Herrell and Dr. Jim Porter, two friends who shared some of this information and some of these neat pictures that I'm going to share with you.
So you may already know this, robotic surgery has been in the field of urology for over 20 years, and urology really was the pioneer of robotic surgery. And so it's been a very fertile field for innovation. There are new technologies, new robots coming out all the time, and that's really what I want to share with you today, and hopefully get you excited.
So the SP robot, for those of you who do robotic surgery, I'm sure you're familiar with the Da Vinci SP by Intuitive. It's been out for about five years now, but has been very slow to be adopted because I think we've now discovered that the SP robot is not the bread-and-butter robot. It's not the robot that everyone is going to be able to use, and it's not the robot that you're going to be able to use for every case.
So it's been slow to be adopted. And although these are examples of patients that I treated with the SP, we can show these really cool pictures of prostatectomies, partial nephrectomies, other cases through a single incision. But really, we weren't yet able to show a clear benefit to doing SP surgery through a single incision rather than doing multi-port robotic surgery.
And we do know that the SP robot does, and there is an increased cost. It may be as much as $2,000 for a prostatectomy to use the SP. But there are some novel approaches that are being used with the SP robot to try to find places where the SP can do things that the Xi or any multi-port robot can't do.
And one of those examples is transvesical surgery, doing an operation through the bladder, operating on the prostate, removing the prostate, or doing a simple prostatectomy through the bladder. It's a pretty amazing concept. It still remains to be seen whether it's the way that most urologists are going to be able to do a prostatectomy, both to learn it and be able to do it well, but it is being investigated. And you could say the SP is still experimental at this point.
Extraperitoneal surgery with the SP is another approach that a lot of surgeons have adopted. Again, we don't really know what the benefit is over doing multi-port extraperitoneal surgery or just doing transperineal surgery with low pressure as I do. But these are things that are still being explored. Again, just a very fertile area in urology for investigation.
The newest player on the scene is the Da Vinci 5, just FDA-approved a couple of months ago and on the market here in the U.S. Not a lot of systems installed yet, but the Da Vinci 5 is here. You can see there's not a big difference in terms of the patient-side cart, the arms and the cart that actually hold the instruments. And not a big difference from the Xi, but the biggest difference is that the instruments now have haptic feedback—so force feedback on the instruments for the first time on a Da Vinci robot.
Also, they're telling us it has 10,000 times the computing power. Maybe there's applications there for AI or other advanced technology. We really don't know. They said the same thing about the Xi, honestly, compared to the Si, that it had 20,000 times the computing power or something like that. It didn't really materialize into anything. So it remains to be seen.
But the other thing that the Da Vinci 5 will do that the previous robots didn't do is that it is going to be collecting a lot of background data on the instrument movement, how many times you're clutching, all of these different things, efficiencies. But again, we don't know what benefit that's going to have. It remains to be seen. It does have better vision. They're saying maybe the procedures will be shorter, you'll save some time on the procedures, but again, it remains to be seen.
Endoluminal robots are coming as well. They already have these for bronchoscopy. J&J has the Monarch, Intuitive has the Ion. So nowadays, bronchoscopies and lung biopsies are being done with endoluminal robots, and it's coming for ureteroscopy as well. There's a Turkish robot and a Korean robot, where you can take any ureteroscope made by any company and put it into the robot and then use the robotic device to control the ureteroscope for whatever procedure you're doing.
And then even rigid cystoscopy has a robot coming. This is the Virtuoso robot. And as you can see here, this would be used for BPH procedures, for TURBTs, but essentially gives you robotic instruments through a rigid scope.
And then technologies ancillary to the robot include exciting things like PSMA fluorescence for prostate cancer, so that you can find involved lymph nodes during a robotic surgery, or you can check your margins, or you can go back and resect tissue that may have been left behind. And then augmented reality, the Holy Grail: being able to use preoperative imaging and then overlay that, place it between the surgeon and the patient using that robot and all the software inside of it to give you almost 3D vision during a robotic operation.
And of course, AI is a hot topic everywhere, also in robotic surgery. So it can be anywhere from something as simple as assessing the performance of a surgeon, all the way up to eventually, maybe someday, the robot's doing the operation without the surgeon. So right now, we are at level zero, no automation, master-slave. That's true of all the robots we use in surgery.
Level five would be complete automation. It's probably coming soon, but somewhere in between would be something like this, where the AI could tell you how much force are you exerting on the tissues? Do you have a positive margin over here, maybe? Where is the safe plane that you should be cutting next? All of those things you can imagine being overlaid during your robotic surgery.
So in conclusion, robotic surgery in urology is still a very fertile field even after 20 years, and the future is coming faster than we expect. Thank you so much for letting me share this with you, and I hope you learned something new and are as excited about the future as I am.
Ronney Abaza: This is Dr. Ronney Abaza, and I'm so happy to be with you to share with you what's new in robotic surgery. These are my disclosures, and I also want to acknowledge Dr. Duke Herrell and Dr. Jim Porter, two friends who shared some of this information and some of these neat pictures that I'm going to share with you.
So you may already know this, robotic surgery has been in the field of urology for over 20 years, and urology really was the pioneer of robotic surgery. And so it's been a very fertile field for innovation. There are new technologies, new robots coming out all the time, and that's really what I want to share with you today, and hopefully get you excited.
So the SP robot, for those of you who do robotic surgery, I'm sure you're familiar with the Da Vinci SP by Intuitive. It's been out for about five years now, but has been very slow to be adopted because I think we've now discovered that the SP robot is not the bread-and-butter robot. It's not the robot that everyone is going to be able to use, and it's not the robot that you're going to be able to use for every case.
So it's been slow to be adopted. And although these are examples of patients that I treated with the SP, we can show these really cool pictures of prostatectomies, partial nephrectomies, other cases through a single incision. But really, we weren't yet able to show a clear benefit to doing SP surgery through a single incision rather than doing multi-port robotic surgery.
And we do know that the SP robot does, and there is an increased cost. It may be as much as $2,000 for a prostatectomy to use the SP. But there are some novel approaches that are being used with the SP robot to try to find places where the SP can do things that the Xi or any multi-port robot can't do.
And one of those examples is transvesical surgery, doing an operation through the bladder, operating on the prostate, removing the prostate, or doing a simple prostatectomy through the bladder. It's a pretty amazing concept. It still remains to be seen whether it's the way that most urologists are going to be able to do a prostatectomy, both to learn it and be able to do it well, but it is being investigated. And you could say the SP is still experimental at this point.
Extraperitoneal surgery with the SP is another approach that a lot of surgeons have adopted. Again, we don't really know what the benefit is over doing multi-port extraperitoneal surgery or just doing transperineal surgery with low pressure as I do. But these are things that are still being explored. Again, just a very fertile area in urology for investigation.
The newest player on the scene is the Da Vinci 5, just FDA-approved a couple of months ago and on the market here in the U.S. Not a lot of systems installed yet, but the Da Vinci 5 is here. You can see there's not a big difference in terms of the patient-side cart, the arms and the cart that actually hold the instruments. And not a big difference from the Xi, but the biggest difference is that the instruments now have haptic feedback—so force feedback on the instruments for the first time on a Da Vinci robot.
Also, they're telling us it has 10,000 times the computing power. Maybe there's applications there for AI or other advanced technology. We really don't know. They said the same thing about the Xi, honestly, compared to the Si, that it had 20,000 times the computing power or something like that. It didn't really materialize into anything. So it remains to be seen.
But the other thing that the Da Vinci 5 will do that the previous robots didn't do is that it is going to be collecting a lot of background data on the instrument movement, how many times you're clutching, all of these different things, efficiencies. But again, we don't know what benefit that's going to have. It remains to be seen. It does have better vision. They're saying maybe the procedures will be shorter, you'll save some time on the procedures, but again, it remains to be seen.
Endoluminal robots are coming as well. They already have these for bronchoscopy. J&J has the Monarch, Intuitive has the Ion. So nowadays, bronchoscopies and lung biopsies are being done with endoluminal robots, and it's coming for ureteroscopy as well. There's a Turkish robot and a Korean robot, where you can take any ureteroscope made by any company and put it into the robot and then use the robotic device to control the ureteroscope for whatever procedure you're doing.
And then even rigid cystoscopy has a robot coming. This is the Virtuoso robot. And as you can see here, this would be used for BPH procedures, for TURBTs, but essentially gives you robotic instruments through a rigid scope.
And then technologies ancillary to the robot include exciting things like PSMA fluorescence for prostate cancer, so that you can find involved lymph nodes during a robotic surgery, or you can check your margins, or you can go back and resect tissue that may have been left behind. And then augmented reality, the Holy Grail: being able to use preoperative imaging and then overlay that, place it between the surgeon and the patient using that robot and all the software inside of it to give you almost 3D vision during a robotic operation.
And of course, AI is a hot topic everywhere, also in robotic surgery. So it can be anywhere from something as simple as assessing the performance of a surgeon, all the way up to eventually, maybe someday, the robot's doing the operation without the surgeon. So right now, we are at level zero, no automation, master-slave. That's true of all the robots we use in surgery.
Level five would be complete automation. It's probably coming soon, but somewhere in between would be something like this, where the AI could tell you how much force are you exerting on the tissues? Do you have a positive margin over here, maybe? Where is the safe plane that you should be cutting next? All of those things you can imagine being overlaid during your robotic surgery.
So in conclusion, robotic surgery in urology is still a very fertile field even after 20 years, and the future is coming faster than we expect. Thank you so much for letting me share this with you, and I hope you learned something new and are as excited about the future as I am.