SPECIALTY SOCIETIES: Preview of Society of Urologic Robotic Surgeons Meeting at AUA in Chicago

By: Craig G. Rogers, MD, FACS, Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan; Samantha Wilder, MD Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan | Posted on: 06 Apr 2023

Robotic surgery has revolutionized the field of urology over the past few decades and is now utilized by surgeons in multiple subspecialties. The Society of Urologic Robotic Surgeons (SURS) strives to help surgeons and their teams improve their robotic surgery skills with the goal of promoting innovative treatments and improved outcomes. The AUA SURS program will be held on Sunday, April 30 (12:30 pm-6 pm) and will provide useful instruction for surgeons and teams at all levels of training and experience in robotic surgery.

The program will consist of short semi-live videos with commentary provided by robotic surgeons in various stages of experience. Veteran robotic surgeons will have the role of moderators and panelists to provide comments and share their experience as they support both rising and established stars in robotic surgery. The meeting will feature a large, diverse faculty of over 18 robotic surgeons, including young faculty, female faculty, and international faculty, as well as endourology fellows and fellowship directors. Specific sessions will be dedicated to early-career robotic surgeons, robotic prostatectomy, single-port robotic surgery, robotic kidney surgery, robotic cystectomy, and robotic reconstructive surgery.

The meeting will start with the Young SURS urologist forum and “Rising Stars” video session, in which our faculty in earlier stages of their careers will share their robotic surgical technique via semi-live video presentations. Awards will be presented to the top videos to acknowledge emerging rising stars in robotic urological surgery. The session will also include a presentation on basic and advanced approaches to robotic surgery training.

Advances in robotic surgical technique have allowed for improved functional recovery following robotic radical prostatectomy. For instance, obtaining support posterior and anterior to the vesicourethral junction can help improve continence following radical prostatectomy. Checcucci et al described the preservation of the space of Retzius, finding better urinary continence outcomes with preservation of anterior structures.1 The “Hood” technique is an anterior approach designed to better preserve the anatomical structures surrounding the urethra, the space of Retzius, and the pouch of Douglas, which may assist in early return of continence.2 The single-port (SP) transvesical approach to robotic prostatectomy helps in preserving apical structures and has been reported to have excellent continence outcomes.3 The robotic radical prostatectomy session will feature presentations from established robotic surgeons focusing on these different techniques to help improve continence.

As surgical systems continue to evolve, the SP robotic surgical system has emerged as another option for minimally invasive surgery. In particular, the SP robot can facilitate an extraperitoneal approach for prostate and kidney surgery, thus expanding surgical options and patient eligibility.4 Extraperitoneal SP robotic prostatectomy has shown good short-term oncological and functional outcomes and has even shown feasibility as an outpatient procedure.5 The SP robotics session will include video review and discussion from high-volume experts in SP surgery regarding their techniques. Utilization of the SP system is likely to increase with continued experience and refinements of the technology, and this session will provide practical guidance in incorporating SP robotics into one’s surgical practice. Faculty will go into troubleshooting and tips for surgeons and teams at any point on the SP learning curve (Figure 1).

Figure 1. Single-port robotic surgery setup, including the single-port access port.

Advancements in robotic surgery have contributed to the increased utilization of robotic partial nephrectomy in patients with high-complexity renal masses. Whether positive margins after nephron-sparing surgery have adverse effects on cancer prognosis remains controversial; however, avoiding positive margins remains our best surrogate for oncological control and is an indicator of surgical quality. The session on robotic kidney surgery will feature semi-live presentations of techniques of tumor excision for complex tumors with the goal of avoiding positive margins, as well as techniques of robotic nephroureterectomy (Figure 2).

Figure 2. Tumor excision in robotic partial nephrectomy of a complex renal mass. Appropriate technique is necessary to ensure negative margins following resection.

The final 2 sessions will include the robotic cystectomy session with both senior moderators and rising star video presenters discussing cystectomy and diversion techniques and the genitourinary robotic reconstruction session with 4 video presenters and 4 moderators discussing upper and lower urinary tract reconstruction techniques. We look forward to a productive afternoon of learning at the AUA SURS meeting from a diverse faculty of robotic experts and rising stars demonstrating their techniques to improve outcomes in robotic urological surgery.

  1. Checcucci E, Veccia A, Fiori C, et al. Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes. BJU Int. 2020;125(1):8-16.
  2. Wagaskar VG, Mittal A, Sobotka S, et al. Hood technique for robotic radical prostatectomy-preserving periurethral anatomical structures in the space of Retzius and sparing the pouch of Douglas, enabling early return of continence without compromising surgical margin rates. Eur Urol. 2021;80(2):213-221.
  3. Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Kaouk J. Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol. 2022;40(8):2001-2008.
  4. Dobbs RW, Halgrimson WR, Talamini S, Vigneswaran HT, Wilson JO, Crivellaro S. Single-port robotic surgery: the next generation of minimally invasive urology. World J Urol. 2020;38(4):897-905.
  5. Wilson CA, Aminsharifi A, Sawczyn G, et al. Outpatient extraperitoneal single-port robotic radical prostatectomy. Urology. 2020;144:142-146.