The AUA 2023 Annual Meeting was a significant platform to discuss advancements in robotic surgery, featuring 33 podium/poster sessions, 11 video sessions, and 7 plenary/satellite sessions dedicated to the subject. Three major themes emerged from the 123 presentations: single-port surgery, next-generation robotic systems, and cutting-edge technologies, particularly surgical artificial intelligence (AI).

Single-port Surgery

The da Vinci SP surgical system has been making strides since its introduction in 2018, as evidenced by its increased installations and the growing number of procedures performed. The SPARC research consortium, comprising 9 institutions, reported promising early findings in single-port surgery.

Ferguson et al reported on how single-port robotic system have enabled various approaches for robotic-assisted radical prostatectomy, namely transperitoneal, extraperitoneal, and transvesical, and compared results between these approaches.¹ They concluded that the transvesical approach is associated with shorter length of stay, faster time to continence, and a lower rate of positive surgical margins compared with other techniques. Ramos et al reported on the results of single-port vs multi-port robotic-assisted simple prostatectomy and found single-port provides more postoperative comfort for patients, especially less opioid use.² Okhawere et al reported transretroperitoneal robotic-assisted partial nephrectomy was feasible and safe compared to transperitoneal robotic-assisted partial nephrectomy.³ Beyond SPARC, other groups have utilized the single-port robotic system for renal auto-transplantation and pediatric robotic pyeloplasty and shown its safety and effectiveness.^4,5 Overall, current studies suggest that the single-port robotic system can be applied safely to the entire urinary tract and is providing equivalent, if not better, clinical outcomes.

Emerging Robotic Systems: A Look at the Future

The introduction of innovative robotic systems, such as Hugo (Medtronic), KangDuo, and Mantra, has been transforming health care on the global stage. Their novel features include open-console designs, modular robotic instrument arms, and, in some cases, eye-tracking functions. According to preliminary reports at AUA2023, these systems provide comparable outcomes to the existing da Vinci robotic system.

Outside of the abdominal/pelvic robotic environment, there has also been enormous innovation of how robotic surgery is being performed. Dr S. Duke Herrell gave talks on Virtuoso, a new endoscopic robotic system. With the innovation of concentric tube manipulators, it allows instruments to be as thin as 1 mm and has the potential to revolutionize conventional cystoscopic and other endoscopic procedures. This new system will be undergoing human testing in the near future.

At the Engineering & Urology Society satellite meeting, Dr Jaime Landman reported the first robotic percutaneous nephrolithotomy by the MONARCH platform performed by Dr Jaime Landman and Dr Mihir Desai together at University of California Irvine.⁶ After decades of robotic systems utilized primarily in urologic oncology, a new robotic system has stepped foot in endourology as well.

Harnessing New Technologies

Dr Francesco Porpiglia’s team showcased an innovative use of augmented reality technology, designed to support surgeons in making intraoperative decisions during vena caval thrombectomy procedures. The technology operates by superimposing reconstructed preoperative imaging on the endoscopic view, effectively mapping the tumor thrombus location relative to the intraoperative tissue view. The team successfully demonstrated in a study with 5 patients that this technology can offer precise guidance in managing this complicated operation.⁷

Hung et al reported on a unified surgical AI system that can achieve multiple tasks, including surgical video segmentation and technical skill assessment for both dissection and suturing procedures.⁸ The system is not only accurate, but also fair and explainable. The system breaks down complex surgical videos into granular segments and eventually gives singular decisions on how well the surgical skill is expected to perform on different surgical technical domains. However, during the system’s development, a phenomenon known as AI model “bias” was observed—the model performed with less accuracy when assessing expert surgeons compared to novices. To mitigate this bias, Hung and his team implemented a combination of class and group balancing strategies along with a “human-in-the-loop” approach.^9,10

The 2023 AUA conference highlighted the rapid evolution of robotic surgery, providing a glimpse into the exciting advancements that lie on the horizon.