Wang Y, Ai Q, Zhao W, et al. Safety and reliability of a robot-assisted laparoscopic telesurgery system: expanding indications in urological surgery. Eur Urol. 2023; 10.1016/j.eururo.2023.11.002.

Special thanks to Drs Grace Chen and Simone Crivellaro at the University of Illinois at Chicago.

Patients who require the specialized skills of a surgeon who works far away often do not have the means to travel for care. Telesurgery presents a compelling solution to this problem and is a natural evolution of the usual modus operandi of robotic surgery, where the surgeon can use a remotely operated console to control robotic arms inside a patient’s body. High latency in data transmission has historically been a key roadblock to the realistic adoption of telesurgery models. In this study, urologists at the Chinese PLA General Hospital in Beijing enrolled live patients to demonstrate the feasibility of a telesurgery model based on 5G wireless technology, a system characterized by low latency and high reliability.

A total of 6 patients volunteered to undergo remote surgery by surgeons operating from 3,000 km away. Ensuring patient safety was of paramount interest, so the authors set up a system where if the communication with the remote surgeon was lost, a local surgeon would be able to take over the case. Remarkably, all cases were successfully completed without requiring conversion to control by the local surgeon. Even more encouraging, all postsurgical parameters were similar to those for local cases. The average total latency of their system was 170 milliseconds, a delay that was perceived to have no significant influence on the surgeon’s experience or performance. This study demonstrates an exciting advance in the possibilities of telehealth, allowing complex surgical intervention to be undertaken remotely and limiting burdens for the patient.

Park SH, Wilson SK, Wen L. Subcoronal incision for inflatable penile prosthesis does not risk glans necrosis. J Urol. 2023;210(4):678-687.

Special thanks to Drs Graham Hale and Samuel Ohlander at the University of Illinois at Chicago.

The subcoronal approach during inflatable penile prosthesis (IPP) placement has been traditionally avoided due to concerns of glans necrosis. But is this fear real? This randomized retrospective review reported outcome data on nearly 900 patients undergoing IPP placement with a subcoronal approach by a single high-volume implant surgeon from 2015 to 2022. There were no reported instances of glans necrosis. About two-thirds of first-time IPP placements were performed using local anesthetic alone, while the remainder continued with the addition of conscious sedation. About one-third of patients were diabetic, but no surgeries were canceled for elevated hemoglobin A1c or preoperative fasting glucose levels.

Only 2 cases of device infection and explantation were reported. There were only 5 cases of distal skin necrosis. After the subcoronal incision was changed from 2 cm proximal to the circumcision scar to the level of the scar, there were no additional instances of skin necrosis. The most common complications were transient and self-resolving: distal penile edema in about three-quarters of cases and incisional paresthesia in about one-fifth.

So was the subcoronal approach innocent all along? These authors present compelling evidence for experienced implant surgeons to question their concerns of glans necrosis during routine IPP placement via a subcoronal approach, especially with the prospect of low infection rates and use of local anesthesia only.

Cheng E, Gereta S, Zhang TR, et al. Same-day discharge vs inpatient robotic-assisted radical prostatectomy: complications, time-driven activity-based costing, and patient satisfaction. J Urol. 2023;210(6):856-864.

Special thanks to Drs Juan Torres and Simone Crivellaro at the University of Illinois at Chicago.

In the midst of the COVID-19 pandemic, the medical community embraced an imperative to reassess established protocols. The same-day discharge model for robotic-assisted radical prostatectomy was introduced, deviating from the historical norm of a period of inpatient care. This strategic adjustment, necessitated by the strain on hospital resources during the pandemic, transcended being a temporary solution and provided a powerful transition toward enhanced efficiency and patient-centered health care.

The authors presented nearly 400 cases of robotic-assisted radical prostatectomy, comparing same-day discharge in about half to the conventional inpatient approach. Complication rates were not significantly different, and same-day discharge resulted in a reduction in about one-fifth of the overall cost. The results of this study signify a paradigm shift in health care delivery. We can and should get patients out of the hospital on the same day as robotic radical prostatectomy.