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In recent years, the adoption of robot-assisted surgery for prostatectomy has seen a significant increase. Among the various systems available, the da Vinci system has established itself as the standard in this domain. Meanwhile, the Hinotori Surgical Robotic System (HSRS) has garnered attention as a promising emerging technology. This paper seeks to systematically evaluate and conduct a meta-analysis comparing the efficacy and safety of HSRS with the da Vinci system in the context of radical prostatectomy (RP). We searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science, to identify studies that utilized HSRS in the context of RP, specifically those comparing it with the da Vinci system. The meta-analysis incorporated five studies that collectively involved a total of 779 patients. The findings indicated that the HSRS cohort experienced a significantly longer operative time compared to the Da Vinci cohort (WMD = 20.42, 95% Cl (6.25, 34.59), p < 0.05). Moreover, the console time for the HSRS cohort was also significantly extended (WMD = 24.14, 95% Cl (16.74, 31.53), p < 0.05). No substantial differences were evident between the two cohorts regarding estimated blood loss, length of stay, urinary incontinence, occurrence of major complications, and the presence of positive surgical margins. In RP, HSRS is associated with extended operative and console times; however, it is similar to the da Vinci system in terms of tumor efficacy and functional recovery. While HSRS demonstrates encouraging clinical applications, there remains a pressing need for extensive, multicenter, high-quality studies to thoroughly assess its effectiveness., Competing Interests: Declarations. Conflict interests: The authors declare no competing interests. Ethics approval and consent to participate: All analyses were based on previous published studies, thus no ethical approval and patient consent are required. Consent for publication: Not applicable., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

We read with great interest the recent meta-analysis by Dai et al. comparing the KangDuo (KD) and da Vinci (DV) robotic systems in radical prostatectomy (RP). Their findings highlight the comparable perioperative outcomes of both systems despite longer operative times with KD. While the study provides valuable insights, we suggest incorporating console time as a key parameter reflecting surgical efficiency and proficiency. Additionally, a pooled analysis of biochemical recurrence (BCR) would enhance the oncological assessment of the two platforms. Lastly, the small sample size limits statistical power, underscoring the need for larger, multi-center studies. Addressing these aspects could further strengthen the study's clinical relevance., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The applications of robotics in urology has been rapidly expanding since the introduction of the Da Vinci robotic platform in 2000. In recent years, there have been further developments in the robotic surgery space including advancements in Da Vinci's own robotic platform, the introduction of a single-port (SP ® ) system, as well as new competitors and adjacent technology that has come to the market. One such technology is the magnetic-assisted robotic surgery (MARS ™ ) from Levita (Mountain View, CA). This system consists of a detachable magnetic grasper that can be placed within the body by a specialized laparoscopic instrument and manipulated from outside the body with an external magnet on a robotic arm that is surgeon controlled. Herein we describe the first dual robotic surgery employing MARS ™ during an SP ® transperitoneal robotic-assisted radical prostatectomy (RARP), demonstrating its feasibility and potential applications for use in single-port surgery in particular., Competing Interests: Declarations. Conflict of interest: Jeffrey Cadeddu is a shareholder of Levita and serves on the advisory board. Ashley Gonzalez and Benjamin Eilender have no disclosures., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: As the prevalence of benign prostatic hyperplasia (BPH) increases, the demand for surgical interventions that optimize patient outcomes while minimizing complications grows. This systematic review compares the efficacy, efficiency, and safety of holmium laser enucleation of the prostate (HoLEP) with robotic-assisted simple prostatectomy (RASP), providing insights for evidence-based surgical decision-making in BPH treatment., Materials and Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the study protocol was registered with Prospero (CRD42024509627). Searches were conducted in Medline, Embase, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature up to February 1, 2024, to include studies that compare HoLEP and RASP in patients with BPH. Risk of bias was evaluated using the Newcastle Ottawa Scale., Results: HoLEP and RASP demonstrated equivalent effectiveness in treating BPH, as shown by similar functional outcomes such as maximum urinary flow rate and postvoid residual volume. However, HoLEP outperformed RASP in several operational efficiency metrics, reducing operative time by 49.48 minutes, hospitalization duration by 1.5 days, and catheterization period by 3.8 days. HoLEP also significantly reduced the risk of blood transfusions by 75%. Patients undergoing RASP were 1.87 times more at risk for grade 2 complications and 3.41 times more at risk for developing grade 3 or above complications., Conclusions: HoLEP and RASP are effective for managing BPH. HoLEP shows advantages in recovery metrics and lower blood transfusion rates, while RASP benefits from ease of implementation in robotic-equipped facilities. Optimizing surgical outcomes will depend on reducing disparities in technique adoption, improving surgical training, and aligning with evidence-based guidelines.

In recent times, innovative surgical robotics have emerged and gained widespread adoption. This study aimed to compare the perioperative outcomes associated with robot-assisted radical prostatectomy (RARP) using three different robotic surgical systems: da Vinci surgical system (DVSS), hinotori surgical robot system (HSRS), and Hugo robot-assisted surgery system (HRASS). Our study involved a retrospective analysis of clinical data from 149 individuals who received RARP from 2022 to 2024, utilizing the DVSS (n = 81), HSRS (n = 52), and HRASS (n = 16). We compared patient characteristics and perioperative outcomes, including complications, console time, and time to console start (i.e., port placement and docking time) among these groups. The Fisher's exact test was used to test categorical variables and Kruskal-Wallis test were used to test continuous variables. Linear model was used to measure the learning rate. The DVSS, HSRS, and HRASS significantly differed in terms of the median operative time (348, 343, 279 min, respectively, p < 0.001); median port placement time (25, 23, 22 min, respectively, p = 0.136); and median docking time (7, 13, 15 min, respectively, p < 0.001). The time to console was shorter with DVSS than with the HSRS and HRASS (p = 0.024). The incidence of perioperative complications was comparable across all three groups, with no statistically significant variations. Compared to other systems, the DVSS showed superior efficiency in both docking and transitioning to console surgery. Although surgeon bias cannot be ruled out in this study, RARP could be safely performed in clinical practice using any of these three models., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: This study received approval from the Ethics Committee of Tottori University Hospital (no. 22A185). Informed consent: Informed consent was waived due to the retrospective design of the study and the use of an opt-out approach for subject inclusion., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Introduction: In the last two decades, several Da Vinci robotic platforms have been released in the market, revolutionizing the field of robotic-assisted surgery (1, 2).The system has seen numerous modifications, with several Da Vinci® robotic models being introduced, each featuring ongoing technological advancements in ergonomics,instrumentation,high-definition imaging, EndoWrist™ technology, and single-port surgery capabilities (3, 4).Building on this, the new generation Da Vinci 5 robot promises significant hardware and software improvements, with the potential for enhanced operative performance (2, 5). In this video, we will illustrate several technical advancements of the Da Vinci 5., Material and Methods: We performed a video compilation comparing the Da Vinci 5 and Da Vinci Xi during radical prostatectomy. The video will highlight the technical modifications of the new platform, showcasing the advancements and improvements in the Da Vinci 5 system. Additionally, this video will illustrate key aspects of the surgery, including anterior bladder neck access, lateral bladder dissection from the prostate, posterior prostate dissection and anastomosis., Surgical Technique: We performed our RARP technique with our standard approach in all patients (6-8). With this new platform, we maintained our conventional technique without any modifications or adaptions from the trocar placement until anastomosis. The beginning of the case is performed as usual, we first identify the anterior bladder neck and then complete its dissection with Maryland and Scissors. Then, we proceed to the posterior bladder neck dissection, seminal vesicles control and nerve-sparing. In sequence, we control the prostate arterial pedicles with hem-o-lok clips and then we perform the apical dissection until dividing the urethra. Finally, we perform the hemostasis, posterior reconstruction (Rocco's technique) and anastomosis with barbed suture., Results: The Da Vinci 5 features several key upgrades. The first part of our video described the console, patient cart, and energy tower modifications. The console has been ergonomically redesigned for a flat neck posture to decrease muscle fatigue, and the handgrip now includes a rubber surface for better grip (9). The patient cart, similar to the previous generation, has updated helm interfaces and integrated commands with the console and vision tower. In sequence, we described the instrument modifications and the step-by-step technique showing the DV5 and DV-Xi. Force feedback instruments provide three degrees of tactile feedback, enhancing tissue manipulation. A new security system ensures instruments can only be inserted when clear of tissues and obstructions, reducing the risk of errors. Another modification regards the ability to switch instruments and camera., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objectives: One of the main advantages of the hinotori™ surgical robot system (HSRS) is that it can be easily adjusted. This study aimed to clarify the effects of modifying the HSRS on the perioperative outcomes of robotic-assisted radical prostatectomy (RARP)., Methods: Overall, 158 cases of RARP using the HSRS were classified into three groups based on the modification to the system: group A (no modification, 70 cases), group B (addition of the ability to switch between two types of scopes and to adjust the arm base tilt back and forth, left and right, 42 cases), and group C (reduction of arm floating sensation, mitigation of emergency stop during arm collision, and addition of clutch function via hand switch in addition to foot pedal, 46 cases). The perioperative outcomes of each group were compared., Results: The median of operation time, cockpit time, and cockpit time excluding the time required for lymph node dissection of group C were 223, 146, and 135 min, respectively, where are significantly shorter than those of group A (308, 228, and 208 min, p < 0.0001, respectively) and group B (319, 241, and 214 min, p < 0.0001, respectively). There was no significant difference in the rate of positive margin rates and the pad-free rate before the first follow-up visit among these three groups. The complication rates in groups A, B, and C were 11.4%, 9.4%, and 8.4% (Clavien-Dindo grades I-II), and 4.3%, 2.4%, and 0% (grade III), respectively., Conclusions: The modifications to the HSRS have enabled smoother surgical procedures for RARP., (© 2024 The Japanese Urological Association.)

To determine the efficacy and adverse consequences between KangDuo and Da Vincii surgical robotic systems in facilitating radical prostatectomy. All the papers, that were included in the current analysis, were identified with PubMed, Embase, and the Cochrane Library through October 1, 2024. To make the comparison easier, only the English-language articles have been used for the analysis and only those focusing on comparing the use of the KangDuo and da Vinci robotic systems in radical prostatectomy were used. There are several avenues of bias when considering articles to include, when selecting the articles for this study to adopt the RCTs and cohort studies and excluding the others, the bias selection targeted was minimal. For the systematic review, 1 cohort study was found as well as 2 RCTs were found that involved 150 adult patients assigned to undergo urological surgery. Of those, 76 patients operated by the Kang Duo robotic system, and the remaining 74 patients operated by the Da Vinci system. In conclusion from this study, it was noted that though there was an increase in the operative time used in the KangDuo system, the estimated blood loss, number of days needed to stay in hospital, and the incidences of postoperative complications were comparable to the other system. Compared to the da Vinci robotic system, the KangDuo robotic system, while associated with longer operative times for radical prostatectomy, showed no significant difference in perioperative or short-term outcomes. In addition, the KangDuo system is more cost-effective and easier to implement in developing countries or other regions. However, further high-quality studies are needed to confirm these findings., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: We compared the surgical outcomes of patients who underwent robot-assisted radical prostatectomy (RARP) using hinotori with those of patients who underwent RARP using da Vinci Xi through propensity score matching to evaluate the potential benefits and efficacy of hinotori., Methods: Perioperative data of patients who underwent RARP between 2017 and 2023 were retrospectively evaluated., Results: After adjusting for preoperative risk factors, each group comprised 118 propensity score-matched patients. Both median total operative time and median console time were significantly longer in the hinotori group (median differences, 26 and 23 min, respectively). Although the hinotori group had lower estimated blood loss, no significant differences were noted between the groups in postoperative complications, positive surgical margin rates, 12-month biochemical recurrence rates, and urinary continence recovery rates., Conclusions: Although RARP requires more time with hinotori, our study demonstrated that RARP can be performed safely and effectively immediately after the installation of hinotori., (© 2024 John Wiley & Sons Ltd.)

A comparison was conducted between robot-assisted radical prostatectomy (RARP) performed using the Hugo RAS System and the Da Vinci System. We conducted an extensive search of online databases through September 2024. The data from eligible studies were pooled and analyzed with Review Manager 5.4, employing a random effects model. Weighted mean difference (WMD) and odds ratios (OR) with 95% confidence intervals (CI) were used to analyze continuous and categorical variables. A total of eight original studies, involving 1155 patients (HUGO-RARP: 468 vs. da Vinci-RARP: 687), were included. Compared with da Vinci-RARP, HUGO-RARP had a longer docking time (WMD: 6.2 min; 95% CI 4.25-8.14; p < 0.0001), while no significant differences were observed in total operative time, console time, bladder neck dissection time, seminal vesicle dissection time, vesicourethral anastomosis time, or pelvic lymph node dissection time between two systems. There were no significant differences in hospital stay, estimated blood loss, catheter duration, or complication rates. Likewise, oncological and functional outcomes were similar between the two systems. While these results suggest that the Hugo RAS system performs as well as the Da Vinci system in RARP, more randomized controlled studies are needed to further evaluate prognostic outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date., Methods: A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed., Results: Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes., Conclusions: This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.

The Hem-o-lok Weck clip is part of a polymer locking ligation system often employed for hemostasis in surgical practices. Its use is routine in a wide array of surgical subspecialties. Surgeons have limited options in removing these clips when they are aberrantly positioned. Herein, we describe a novel, cost-effective approach for removing a Hem-o-lok clip using standard robotic instruments. This simple approach will allow surgeons to remove a Hem-o-lok clip precisely and quickly if it is not adequately placed. During a routine robotic-assisted laparoscopic prostatectomy a Hem-o-lok Weck clip was noted to be in juxtaposition to the rectal wall, and it was deemed appropriate to remove it. Ultimately, the indwelling Prograsp forceps was moved from the right fourth arm position to the left arm position. This allowed the Prograsp forceps to compress the scissors in the right hand port, which was insufficient in cutting the hinge of the clip. This provided sufficient force to cut through the clip at its hinge with ease. The Hem-o-lok Weck clip is used in various surgical specialties. It is occasionally placed suboptimally and requires removal. Given the challenge of finding and using the clip removal device, surgeons should be aware of this simple and cost-effective way of removing a Hem-o-lok clip if desired.

Urology's pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci ® system faced new competition following its 2019 patent expiration. Medtronic's Hugo ™ system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo ™ robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo ™ platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo ™ as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci ® system, fostering global Hugo ™ adoption. Despite evidence demonstrating Hugo ™ safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges., (© 2024. The Author(s).)

Because of the increasing popularity of Hugo RAS as a surgical platform, a comparison examination of intraoperative and oncological outcomes across DaVinci and Hugo RAS robotic surgery platforms is urgently needed. We carried out a comprehensive review and meta-analysis of the literature of current research, comprehensively searching PubMed, Cochrane and Embase for eligible studies comparing the results between the DaVinci and Hugo RAS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in the conduct of this study, with language restricted to English and a final search date of June 2024. We excluded articles composed solely of conference abstracts and irrelevant content. Composite outcomes were assessed using weighted mean differences (WMD) and odds ratios (ORs). The risk of bias in individual research was assessed using the Newcastle-Ottawa Scale (NOS), and heterogeneity and bias risk were controlled for using a sensitivity analysis. Six studies in all were considered, comprising 1025 patients, including 626 DaVinci patients and 399 Hugo RAS patients. Review Manager V5.4.1 software (Cochrane Collaboration, Oxford, UK) was utilized to conduct the meta-analysis, including 6 trials, which demonstrated that compared to Hugo RAS, DaVinci was associated with statistically significant differences in several outcomes: a reduction in operative time (OT) (WMD - 8.46, 95% CI - 13.56 to 3.36; p = 0.001), an increase in estimated blood loss (EBL) (WMD 41.68, 95% CI 23.59 to 59.77; p < 0.00001), and an increased pelvic lymphadenectomy ratio (OR 1.5, 95% CI 1.05-2.05; p = 0.01). On the contrary, there were no statistically noteworthy differences in the length of hospital stay (LOS) between the two teams (WMD - 0.05, 95% CI - 0.14 to 0.04; p = 0.25), nerve sparing (unilateral or bilateral) (OR 0.96, 95% CI 0.68-1.35; p = 0.8), postoperative complications (OR 1.15, 95% CI 0.50-2.64; p = 0.75), or positive surgical margins (PSM) (OR 1.08, 95% CI 0.76-1.54; p = 0.68). Although DaVinci offers shorter operating times (OT) and increased pelvic lymph node dissection rates, Hugo RAS demonstrates lower estimated blood loss (EBL). Overall, Hugo RAS Robot-Assisted Radical Prostatectomy (RARP) results seem to be similar to those obtained with the DaVinci system. Further research and long-term follow-up are necessary to ascertain durable oncological and functional outcomes, allowing doctors to switch between robotic systems and use their skills. These findings are crucial for patients, surgeons, and healthcare policymakers and warrant future studies with extended follow-up., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: The aim of this study is to describe the first series of six patients undergoing Retzius-sparing robot-assisted radical prostatectomy (rs-RARP) using the hinotori surgical robot system (hinotori SRS) and to compare the treatment outcomes with those achieved with the da Vinci surgical platform., Methods: This study included 20 cases involving the rs-RARP procedure (hinotori: N = 6; da Vinci: N = 14) that were performed between May 2021 and April 2024 in a single institution., Results: No significant differences were observed between the hinotori and da Vinci groups regarding the preoperative findings. In the hinotori group, there were four cases of pT2 that showed negative surgical margins in all the cases. However, positive surgical margins were observed in two of the cases with pT3. The surgical outcomes were also similar between the two groups except for console time, which tended to be shorter in the da Vinci group ( p = 0.058). There were no major complications in the initial six cases with the hinotori SRS. Immediate urinary continence was observed in 50% of the cases with the hinotori group compared with 64% for the da Vinci group., Conclusion: This is the first study to report cases of rs-RARP performed on a hinotori SRS. It seems that the hinotori SRS shows similar treatment outcomes compared with the cases treated via the da Vinci platform.

Purpose: Currently, the rigid instruments used for laparoscopic radical resection of prostate cancer not only have the risk of damage to tissues, blood vessels, and nerves, but their limited freedom will also cause surgical blind areas. Soft robots are expected to solve these issues due to inherent flexibility, compliance, and safe interaction with tissues and organs. In addition, to achieve high surgical accuracy and provide precise guidance for surgeons, the navigation method should be studied for the soft robot., Methods: A soft robot system for single-port transvesical radical prostatectomy (STRP) is developed, and a navigation method combining fiber Bragg gratings and electromagnetic tracking is proposed for the soft robot. To validate the soft robot design and the effectiveness of the navigation method, different groups of experiments are conducted., Results: The proposed navigation method can achieve accurate location and shape sensing of the soft manipulator. The experiments show that the maximum tip sensing error is 2.691 mm, which is 5.38 % of the robot length for static configurations, and that the average tip sensing error is 1.966 mm, which corresponds to 3.93 % of the robot length for dynamic scenarios. Additionally, phantom tests demonstrate that the designed soft robot can enter the prostate through navigation guidance in a master-slave control mode and cover the entire prostate space., Conclusions: The designed soft robot system, due to its soft structure, good flexibility, and accurate navigation, is expected to improve surgical safety and precision, thereby exhibiting significant potential for STRP., (© 2024. CARS.)

The evolution of laser medical devices for benign prostatic hyperplasia (BPH) treatment aims to enhance vaporization, coagulation, or tissue removal. In this study, we aim to evaluate the effectiveness and safety of the innovative application of insulated-gate bipolar transistor (IGBT) xenon lamp-pulsed drive technology holmium laser in endoscopic prostate enucleation operations using canine models. Six canines were used as an experimental unit, the breed of the canine unit used was beagle. Each canine served as its own control to minimize the number of experimental units. Endoscopic enucleation, performed by a single surgeon, involved enucleating the left hemi-prostate, leaving the right hem-prostate untouched to serve as the control. Throughout the study period, all canines maintained good health. No adverse events were observed in all six canines. Postoperatively, there were no indications of redness, swelling, or other adverse effects at the surgical sites. No abnormalities were observed in the appearance and morphology of major organs. The prostate and bladder, removed for further pathological evaluation, exhibited no abnormalities in size, color, or texture. No abnormalities or inflammation were observed, and the tissues were free of adhesions, indicating successful healing. In conclusion, our comparison of preoperative and postoperative parameters in canines suggests that the IGBT pulsed laser, at a power setting of 100 W, demonstrates characteristics of safety, efficacy, minimal tissue damage, and no major postoperative complications. This study establishes a theoretical foundation for future applications in human settings, encouraging further exploration of the IGBT holmium laser's potential in clinical practice., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

This meta-analysis aimed to compare perioperative outcome measures between the AirSeal system and conventional insufflation system in robot-assisted laparoscopic prostatectomy. Up to May 2024, comprehensive searches were conducted across various prominent databases worldwide, such as PubMed, Embase, and Google Scholar, focusing solely on English-language materials. Reviews and protocols devoid of published data were excluded, along with conference abstracts and articles unrelated to the study's aims. Primary outcome measures encompassed operative duration and hospitalization length, while secondary outcome measures included estimated blood loss and complications. The meta-analysis included five cohort studies, encompassing a total of 1503 patients. In comparison to the conventional insufflation system group, the AirSeal group displayed shorter operative times (WMD - 15.62, 95% CI - 21.87 to - 9.37; p < 0.00001) and reduced hospital stays (WMD - 0.45, 95% CI - 0.60 to - 0.30; p < 0.00001). Fewer major complications (OR 0.15, 95% CI 0.03 to 0.66; p = 0.01). Notably, there were no significant differences observed in estimated blood loss or overall complications between the two groups. Compared to conventional insufflation systems, employing the AirSeal system in robot-assisted laparoscopic radical prostatectomy appears to potentially decrease operative time and hospital length of stay without a concurrent rise in estimated blood loss or complication rates., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Robotic surgery with Da Vinci has revolutionized the treatment of several diseases, including prostate cancer; nevertheless, costs remain the major drawback. Recently, new robotic platforms entered the market aiming to reduce costs and improve the access to robotic surgery. The aim of the study is to compare direct cost for initial hospital stay of radical prostatectomy performed with two different robotic systems, the Da Vinci and the new Hugo RAS system. This is a projection study that applies cost of robotic surgery, derived from a local tender, to the clinical course of robotic radical prostatectomy (RALP) performed with Da Vinci and Hugo RAS. The study was performed in a public referral center for robotic surgery equipped with both systems. The cost of robotic surgery from a local tender were considered and included rent, annual maintenance, and a per-procedure fee covering the setup of four robotic instruments. Those costs were applied to patients who underwent RALP with both systems since November 2022. The primary endpoint is to evaluate direct costs of initial hospital stay for Da Vinci and Hugo RAS, by considering equipment costs (as derived from the tender), and costs of theater and of hospitalization. The direct per-procedure cost is €2,246.31 for a Da Vinci procedure and €1995 for a Hugo RALP. In the local setting, Hugo RAS provides 11% of cost saving for RALP. By applying this per-procedure cost to our clinical data, the expenditure for the entire index hospitalization is € 6.7755,1 for Da Vinci and € 6.637,15 for Hugo RALP. The new Hugo RAS system is willing to reduce direct expenditures of robotic surgery for RALP; furthermore, it provides similar peri-operative outcomes compared to the Da Vinci. However, other drivers of costs should be taken into account, such as the duration of OR use-that is more than just console time and may depend on the facility's background and organization. Further variations in direct costs of robotic systems are related to caseload, local agreements and negotiations. Thus, cost comparison of new robotic platform still remains an ongoing issue., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Introduction: Robotic surgery using da Vinci surgical system has gained prominence in urology; emerging robotic platforms are expanding its applications and increasing affordability. We assess the feasibility and safety of a novel system, the Toumai ® robotic system in various urological surgeries. Methods: This prospective study was conducted at the first affiliated hospital of Zhengzhou university. Twenty consecutive patients underwent renal and prostatic surgery with the Toumai. The study assessed technical feasibility (conversion rate) and safety (perioperative complications) of the procedures as primary outcomes. Secondary endpoints included key surgical perioperative outcomes: functional and oncologic results. The Endoscopic Surgical System operates within a master-slave protocol, comprising a Surgeon Console, Patient Platform, and Vision Platform. Results: Seventeen patients underwent various nephrectomy procedures and three underwent radical prostatectomy (RP). There was no conversion to alternative surgical approach; a single (Clavien-Dindo grade ≥3b) complication occurred, and no readmission was recorded within 30 days. The median operative time was 120, 140, and 210 minutes for partial nephrectomy (PN), radical nephrectomy, and RP, respectively. Off-clamp PN was performed in one case, and the warm ischemia time in the remaining two case was 18 minutes. The median docking time was 22 minutes for nephrectomy and 20 minutes for RP; no major robotic malfunction was encountered. At 3-month follow-up, no tumor recurrence was recorded, renal function was well preserved, and the continence status was satisfactory. Conclusions: We present the initial clinical utilization of an innovative robotic platform. Complex urological surgeries were successfully completed without conversions and with minimal complications. Further investigations are warranted to confirm these initial findings.

In the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical approach in the majority of major surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. Of these, hinotori, the first made-in-Japan robotic system, is characterized by various unique and attractive features different from the existing system, and the use of this system has gradually increased mainly in urologic cancer surgeries, including radical prostatectomy, partial nephrectomy, radical nephrectomy, and radical nephroureterectomy. This review initially describes detailed characteristics of hinotori, then summarizes the early experience with urologic cancer surgeries using hinotori at our institution, and finally discusses the future prospects of robotic surgery using hinotori, considering problems associated with the use of this robotic system., (© 2024. The Author(s).)

The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: To determine the incidence and predictive factors for conversion to an open procedure during Holmium Laser Enucleation of Prostate (HoLEP)., Methods: A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2020. Data collected included demographics, pre-operative estimated prostate size, intraoperative data, pathologic data, and functional baseline. A univariate and multivariate comparison between the pre-operative data of converted and un-converted cases was conducted., Results: Among a total of 807 HoLEP procedure performed during the above period, 20 cases were converted to open procedures (2.4%). Median pre-operative estimated prostate size in cases of conversion was 228ml compared to 95ml for unconverted cases (P <.001). The reasons for conversion were anatomical in 8 cases (40%), bleeding that was difficult to control endoscopically in 4 cases (20%), expected procedure to be too long due to large prostate size in 6 cases (30%), one case of morcellation technical malfunction, and one case with very large bladder stones not suitable for endoscopic treatment. Prostate size was the only factor that was found to be associated with conversion in univariate and multivariate analysis., Conclusion: The risk of conversion of HoLEP to open procedures is size-dependent. The risk for conversion to open prostatectomy/cystotomy must be communicated to patients who choose HoLEP to improve the informed consent process and provide the highest quality of patient care and transparency. Open prostatectomy/cystotomy should be a part of the armamentarium of every HoLEP surgeon operating on large prostates., (Copyright © 2021 Elsevier Inc. All rights reserved.)

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients (P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group (P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group (P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group (P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively (P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients., Competing Interests: None

Purpose: Previously published studies have shown small prostate size, capsular perforation and intraoperative bladder distension are associated with failed trial without a catheter (TWOC) after HoLEP. The study objective was to determine the relationship between MOSES pulse modulation versus standard laser technology and short-term catheter reinsertion following failed TWOC., Materials and Methods: The study included 487 patients who underwent HoLEP, using standard holmium laser settings (180 patients) or MOSES pulse modulation (255 patients), between August 2018 and February 2021. Catheter reinsertion defined as reinsertion following failed TWOC within 30 days of surgery. Association of pulse modulation with catheter reinsertion was examined using single and multivariable logistic regression models. Comparisons of pre and intraoperative characteristics between patients treated without and with pulse modulation were made using a Wilcoxon rank sum test for numeric characteristics or Fisher's exact test for categorical characteristics., Results: Short-term catheter reinsertion occurred in 14% (26/180) of the standard laser setting group as compared with 10% (24/252) of the pulse modulation group. There was no statistically significant association with short-term catheter reinsertion in single (unadjusted OR [standard settings vs. pulse modulation], 1.60; 95% CI, 0.80-2.91; p=0.12) or multivariable analysis adjusting for specimen weight and operative time (adjusted OR [standard settings vs. pulse modulation], 1.44; 95% CI, 0.77-2.68; p=0.25)., Conclusions: In this study, we found no association between post-HoLEP short-term catheter reinsertion following failed TWOC and MOSES pulse modulation. Although MOSES pulse modulation offers several well-documented advantages, catheter reinsertion events appear to be attributable to other factors., Competing Interests: Chandler D. Dora, MD has received payment from Lumenis, LTD for speaking engagements, panel participation and case observation. The other authors have no conflicts of interest to declare., (© The Korean Urological Association, 2021.)

Objective: To examine voluntary reports in the Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, categorize complications and assign device-related causality with transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), and transurethral water vapor therapy (TWVT)., Methods: A review was performed using the terms "Urolift," "Rezum," and "transurethral resection of the prostate" between 01/01/2015 and 12/31/2019. Duplicate and incomplete reports were excluded. The Gupta system was used to report complications and device related causality. 1 Pearson's Chi-square analysis was performed to compare minor (Level 1) versus major (Levels 2-4) complications., Results: A total of 548 events were examined. After removal of duplicates (n = 60), irrelevant reports (n=65), and incomplete information (n = 14), we included 409 events (74.6%). Of the 409 events, 214 were for TURP, 112 for TWVT, and 83 for PUL. In aggregate, 39.4% of events were minor/Level 1 (n=161/409). The proportion of subjects with Level 2-4 complications versus Level 1 complications was significantly higher for PUL than TURP or TWVT [X 2 (2, N = 408) = 41.4023, P < .00001]. Device causality was attributable to device malfunction in 60.4% of cases (n=247/409)., Conclusion: Device malfunction was noted in all groups and 39.4% of these were minor (Level 1). However, the majority of PUL reports noted a Level 3 or 4 complication (50.6%, 42/83), primarily bleeding related. Previous studies have not revealed significant risk of bleeding and suggests a discrepancy between study data and real-world experience that may alter patient counseling practices., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Aquablation using the AquaBeam system combines real-time image guidance and robotics to enable precise and heat-free removal of prostatic tissue with a high velocity water jet. The aim of this study is to report the outcomes of Aquablation up to 1 year in a single centre within the UK employing an athermal approach to haemostasis., Methods: Fifty-five consecutive men underwent Aquablation between September 2017 and December 2018 (as part of OPEN WATER trial). Standard Aquablation was performed with the AquaBeam system (PROCEPT ® BioRobotics) with 2 passes of Aquablation followed by bladder washout with application of continuous bladder irrigation via a catheter on a continuous traction device. Patients were followed up at 3 and 12 months. The data were prospectively collected on patient demographics, uroflowmetry, prostate volume, International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF-15)., Results: The mean age was 64.1 ± 7.9 years. Operating time was 26.9 ± 9.2 min. Mean prostate volume decreased from 58.2 ± 23.9 cc to 33.2 ± 12.9 cc (p < 0.0001). There were significant improvements at the 12 month follow-up in maximum urinary flow rate (9.9 ± 5.1 ml/s vs. 23.9 ± 11.6 ml/s), IPSS (21.7 ± 7.4 vs. 6.1 ± 4.2) and quality of life score (4.8 ± 1.1 vs. 1.4 ± 1.4) (p < 0.0001). There was no significant change in IIEF-15 and MSHQ-EjD scores. There were 8 (14.5%) Clavien grade 2 or higher complications., Conclusion: Our single centre experience suggests Aquablation using an entirely athermal approach is a safe cavitating procedure resulting in significant LUTS improvement comparable to standard cavitating procedures with greater preservation of sexual function., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To describe the novel technique of photoselective sharp enucleation of the prostate (PSEP) with a front-firing 532-nm laser and evaluate its efficacy and safety., Methods: A seven-step standardized surgical procedure was established, and PSEP was performed in an en bloc or lobulate manner according to the size of the middle lobe of the prostate. The following clinical data of 583 patients who underwent PSEP in our center from November 2016 to May 2018 were retrospectively reviewed: maximum flow rate (Q max ), International Prostate Symptom Score (IPSS), quality of life score (Q ols ), post-void residual volume (PVR), prostate volume, operation time, serum prostate-specific antigen (PSA) concentration, and complications at 1, 6, and 12 months postoperatively., Results: Of the 583 patients, 475 had complete clinical information and were included in the study. The median operation time was 39 min. There were significant improvements in the Q max , IPSS, Q ols , PVR and PSA concentration at each follow-up time point postoperatively. Postoperative hemorrhage occurred in 22 patients (4.6%), urinary retention in 29 (6.1%), urinary tract infection in 55 (11.6%), bladder neck contracture in 8 (1.7%), urethral strictures in 11 (2.3%), and stress urinary incontinence in 9 (1.9%)., Conclusions: PSEP is effective and safe for the treatment of benign prostatic hyperplasia. The innovative technique integrates the excellent hemostatic property of the 532-nm laser and the high efficiency of enucleation. It decreases the occurrence of postoperative incontinence associated with "blunt" enucleation of 532-nm laser and eliminates the lack of tissue samples problem associated with photoselective vaporization of the prostate., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Purpose: In order to increase the efficiency of the low-power holmium laser enucleation of the prostate (LP-HoLEP), and introduce it as a standard surgery for BPH, we described a modified 'seven-step two-lobe' HoLEP (ST HoLEP) technique applying 60-W device in a stepwise manner., Methods: From July 2016 to August 2019, 120 patients who received LP-HoLEP at our hospital because of urinary tract symptoms caused by BPH were included in the study. The patients were assigned into two groups, 60 consecutive patients received modified ST HoLEP compared with another preexisting 60 consecutive patients who received the conventional three-lobe HoLEP (T HoLEP) before the technical modification. The clinical parameters, including patient characteristics, perioperative data, as well as voiding outcomes, and complications were evaluated after at least 3-month follow-up., Results: The median enucleation efficiency of the ST HoLEP was 0.72 gm/min, which was significantly higher than 0.62 gm/min of the T HoLEP. Despite the preoperative IPSS was slightly higher in T HoLEP group, the other preoperative and perioperative data showed no statistical difference between the two groups. After ST HoLEP procedure, the urinary incontinence rate was continually improved at 1-week, 1-month, and 3-month follow-up which were 13.3%, 6.7%, and 1.7%, respectively. There was no significant difference in postoperative voiding outcomes and urinary continence results in 3-month follow-up., Conclusion: The ST HoLEP technique was proved to increase the efficiency which was benefit from minimizing the surgical incision, facilitating the single surgical plane identification and maintenance during the whole enucleation procedure., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Aim of the study was to evaluate efficacy and efficiency of 180-watt Green-Light XPS (GL-XPS) laser photoselective vaporization of the prostate (PVP) in patients under 5-Alpha-Reductase Inhibitors (5ARI) treatment., Patients and Methods: A consecutive series of patients with lower urinary tract symptoms due to benign prostatic enlargement treated by PVP with the GL-XPS were enrolled. Patients were divided in two groups according to the chronic use (>6 months) of 5ARI. These two groups were compared on lasing density (kilojoules per prostate volume), vaporization efficiency (prostate volume per lasing time), vaporization power (kilojoules per lasing time), Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. Follow-up was performed at 3, 6 and 12 months with International Prostate Symptom Score, Uroflowmetry parameters and PSA., Results: Overall 193 patients were enrolled. Out of them 87/193 (45%) were on 5ARI treatment. No significant differences were recorded between the two groups at baseline. Median age was 68 years old and median prostate volume was 60 ml. In terms of laser efficiency, no statistically significant differences were recorded in terms of lasing time (25 min vs. 24.5 min; p>0.05); energy used (250 kJ vs. 221 kJ; p>0.05), lasing density (6.8 kJ/ml vs. 6.6 kJ/ml, p>0.05), vaporization efficiency (1.4 ml/min vs. 1.3 ml/min, p>0.05) and vaporization power (9.6 kJ/min vs. 9.4 kJ/min; p>0.05). Finally, no significant differences were also recorded postoperatively in the two groups in terms of PSA reduction, improvement in symptom score and uroflowmetry parameters (p>0.05)., Conclusions: Thirty-seven efficacy and efficiency outcomes were not statistically different between the two groups. 5ARI does not reduce the performance and ability of the 180-watt Green-Light XPS laser system.

Background and Objective: Few studies have investigated the association between surgical volume and outcome of robot-assisted radical prostatectomy (RARP) in an unselected cohort. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group., Methods: 9,810 RARP's registered in the National Prostate Cancer Register of Sweden (2015-2018) were included. Associations between outcome and volume were analyzed with multivariable logistic regression including age, PSA-density, number of positive biopsy cores, cT stage, Gleason score, and extent of lymph node dissection., Results: Surgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon (OR 9.20, 95% CI 7.11-11.91), hospital (OR 2.16, 95% CI 1.53-3.06), less blood loss; surgeon (OR 2.58. 95% CI 2.07-3.21) hospital (no difference), more often nerve sparing intention; surgeon (OR 2.89, 95% CI 2.34-3.57), hospital (OR 2.02, 95% CI 1.66-2.44), negative margins; surgeon (OR 1.90, 95% CI 1.54-2.35), hospital (OR 1.28, 95% CI 1.07-1.53). There was wide range in outcome between hospitals and surgeons with similar volume that remained after adjustment., Conclusions: High surgeon and hospital volume were associated with better outcomes. The range in outcome was wide in all volume groups, which indicates that factors besides volume are of importance. Registration of surgical performance is essential for quality control and improvement., Competing Interests: RAG has received lecture fees from IPSEN and Astellas. All other authors report no competing interest in any stage of this research work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Robotic prostatectomy is the most commonly performed robotic procedure in the United States. Increasing utilization of this procedure necessitates characterization of robot malfunctions and associated patient injuries. We performed a review of adverse events reported to a publicly available database. We searched the Manufacturer and User Facility Device Experience (MAUDE) database for reported adverse events (RAE) involving the intuitive surgical system. Reports involving prostatectomy from 2014 to 2019 were extracted and analyzed for data regarding death, patient injury, and device malfunction. Of 9109 reported adverse events (RAE), 602 were extracted for robotic prostatectomy over the study period. Seven were patient deaths (1.2%), 53 (8.8%) were patient injuries (Table 1), and 542 (90.0%) were malfunctions (Table 2). Malfunctions resulted in 25 aborted cases, 21 open conversions, and 25 laparoscopic conversions (71/542, 13.1%; Fig. 1). Instrument failures comprised the majority (76.4%) of malfunctions. Seven malfunctions (1.3%) resulted in patient injury. The most common device-related injury involved the monopolar curved scissors. No reported deaths were related to robot malfunction. Instrument failures comprise majority of the malfunctions of the Da Vinci robot during robot-assisted laparoscopic prostatectomy. When malfunctions do occur they are usually recoverable and rarely lead to patient injury.

Objective: To gain insight from the experience of learning Holmium laser enucleation of the prostate (HoLEP), teaching HoLEP, and the current HoLEP practice patterns of fellowship-trained endourologists., Methods: Surveys were electronically distributed to United States (U.S.) practicing urologists who completed American Endourology fellowships (that included HoLEP) within the past 6 years. Questions focused on HoLEP training and current practice patterns., Results: As of September 2019, 12% (6/49) of U.S. endourology fellowships reported including HoLEP as a component of training. With a 73% response rate (16 of 22), 81% participated in over 20 cases during training, while 50% participated in over 50. A total of 25% independently completed over 50 cases from start to finish. At training completion, most (80%) felt comfortable/somewhat comfortable completing an entire HoLEP independently and managing post-op complications. Seventy-five percent practice HoLEP currently, and 25% teach to trainees. When asked "What is most challenging about HoLEP in current practice?" common responses were: efficiency/profitability concerns, poor reimbursement, educating OR/hospital staff, establishing case volume, minimizing sphincter trauma, and large glands (>200gm)., Conclusion: With diverse exposure in fellowship, most incorporate HoLEP into their practice after training. Aspects of the procedure remain challenging after several years of experience. Profitability/reimbursement concerns should be further explored to increase HoLEP adoption., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine if MOSES technology improves efficiency and short-term outcomes in holmium laser ablation of the prostate (HoLAP)., Methods: A retrospective review of patients who underwent HoLAP between August 2016 and November 2019 was conducted. All procedures before and after the implementation of MOSES technology at our institution were evaluated. Preoperative patient characteristics and intraoperative data were collected. Postoperative International Prostate Symptom Score, quality of life, and postvoid residual measurements at 6 weeks and 3 months postoperatively were analyzed., Results: This cohort included 65 males who underwent HoLAP, 32 without and 33 with MOSES. Patients in the MOSES group were slightly older, but no other differences in baseline characteristics were observed between the two groups. Ablation time was similar at 49.6 ± 26.1 minutes without and 40.7 ± 41.2 minutes with MOSES (P = .38). However, HoLAP with MOSES had significantly higher ablation efficiency (0.59 ± 0.24 g/min without vs 0.86 0.5 g/min with MOSES, P = .01). On multivariable regression modeling, HoLAP without MOSES added 12 minutes to operating time (estimate 12.3, standard error 3.44, P < .01) after controlling for prostate size and laser energy usage. Duration of catheterization, urinary incontinence and need for reoperation within 3 months were similar. There were no differences between groups in International Prostate Symptom Score, quality of life, or postvoid residual at 3 months postoperatively., Conclusion: Utilization of MOSES technology resulted in improved efficiency in HoLAP, translating into time savings in the operating room. Postoperative outcomes out to 3 months were similar among patients who underwent the procedure utilizing either laser pulse mode. Further studies are needed to investigate long-term outcomes as the use of MOSES is likely to become more commonly utilized., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To provide a comprehensive review on the new da Vinci SP (single port) robotic surgical system. The published literature to date within urology and a description of the new system will be discussed., Findings: There are currently no high-quality published studies with the SP robotic system. All studies are case series, many with 10 or fewer patients. However, all studies have found the SP system to be safe and feasible in performing most urological procedures. Renal and pelvic surgery using the SP robotic system is safe and feasible in the hands of expert robotic surgeons. Long-term, high-quality data is lacking. While the current high price and the learning curve will limit the SP systems' use in many health care systems, new updates and the release of robotic surgical systems from other developers may help drive down costs and encourage uptake.

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time., Competing Interests: Disclosure None of the authors have any financial disclosures or conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To describe the crucial factors related to the implementation of the da Vinci single-port (SP) system (Intuitive Surgical Inc., Sunnyvale, CA, USA), and the early outcomes after the introduction of this robot for robot-assisted radical prostatectomy (RARP)., Patients and Methods: We prospectively collected data from 50 consecutive patients with prostate adenocarcinoma who underwent RARP using this robot. The median follow-up was 53 days. We performed a transperitoneal technique. The robotic (multiport) trocar was placed on the supra-umbilical midline 20 cm from the pubis and an assistant trocar placed in the right lower quadrant. We report our initial experience describing the intra- and postoperative outcomes associated with this new robot. Also, we report the early functional and oncological outcomes in the follow-up period considered. Continuous variables were described as medians and interquartile ranges, while categorical variables as frequencies and proportions., Results: The median total operative time was 118 min, median console time was 80 min, and median estimated blood loss was 50 mL. There were no intraoperative complications or blood transfusions. The final pathology reported 18% Grade Group (GrGp)1, 58% GrGp2, 18% GrGp3, 2% GrGp4, and 4% GrGp5. In all, 40 patients (80%) were pT2 and 20% were ≥pT3a. The overall positive surgical margin rate was 14%. In all, 39 patients (78%) achieved full continence at median of 21 days after RARP. The median pain scale (0-10) score at 8, 12 and 16 h after RARP was 2, 2, and 0, respectively., Conclusion: The use of the da Vinci SP robot with an additional assistant port for RARP is technically safe and feasible, with acceptable short-term functional and oncological outcomes. However, there is a technical learning curve for this new platform due to the smaller scope of the operative field and the decreased flexibility and strength of the surgical instruments., (© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.)

Purpose: To compare the erectile function and urinary continence of patients after single-port transvesical laparoscopic radical prostatectomy (STLRP) with intrafascial endoscopic extraperitoneal radical prostatectomy (IEERP)., Materials and Methods: Patients treated with STLRP (35) or IEERP (52) were recruited from September 2013 to June 2017. At baseline preoperatively and 2-year follow-up postoperatively, sex and continence assessments were performed by International Index of Erectile Function-6 (IIEF-6) and daily pads, respectively., Results: The sexual function at 3 months after RP declined obviously. 71.4% (STLRP) and 38.5% (IEERP) patients recovered potency at 6 months postoperatively (P < .01). 82.9% (STLRP) and 59.6% (IEERP) patients recovered potency at 2 years postoperatively (P < .05). 97.1% (STLRP) and 75.0% (IEERP) patients recovered continence (0 pad/day) at 3 months postoperatively (P < .01). Continence achieved 100.0% at 2 years after RP in both groups., Conclusion: Patients receiving STLRP may obtain better and faster postoperative functional recovery than the ones receiving IEERP. As an exploratory research, STLRP may be another effective treatment for organ-confined prostate cancer.

Objective: To assess the safety and feasibility of extraperitoneal single-port robotic assisted laparoscopic radical prostatectomy using the da Vinci SP robotic platform for same-day surgery., Methods: Extraperitoneal single-port robotic prostatectomy (ESRP) using the da Vinci SP platform was performed on 60 patients with clinically localized prostate cancer and no prior definitive therapy. An enhanced recovery protocol was used in the perioperative period and minimal to no opiates were used in these patients. Preoperative, perioperative, and postoperative data were collected in a prospectively maintained institutional review board approved database and evaluated in a retrospective fashion., Results: Mean operative time was 198 minutes and mean estimated blood loss was 179 mL. No patients required blood transfusion and there were no intraoperative complications. Pain at discharge was 0-1 in 37% of patients. Forty-five patients (75%) were discharged home the day of surgery, including patients with all surgical start times. When excluding patients that were planned for an overnight stay preoperatively or patients whose surgery finished after 6 PM, 88% of patients were discharged home the day of surgery and 96% were discharged within 24 hours of surgery. Median length of stay was 4.2 hours. Fourty-eight percent of patients required 0-1 pads at 30 days postoperatively in patients with 30 day follow data (n = 58) and 76% of patients reported requiring 0-1 pads per day by 90 days postoperatively (n = 37)., Conclusion: ESRP using the da Vinci SP platform can be performed safely and reproducibly as a same-day outpatient surgery with minimal to no opiate use, excellent pain control, and acceptable short term functional and oncological outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Transurethral resection of the prostate (TURP) is the first choice for the treatment of benign prostatic hyperplasia. However, Transurethral split of prostate (TUSP) also seems to have clear clinical efficacy and clinical promotion value. To better clarify the potential and limitations of this treatment of prostate hyperplasia. This study objectively evaluated the clinical efficacy and safety of TUSP., Methods: The Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Database for Chinese Technical Periodicals (VIP), Wanfang (Wanfang data), and SinoMed databases were searched for relevant studies. We then used Revman Manager 5.3 to perform a meta-analysis of all randomized controlled trials that evaluated the efficacy and safety of TUSP versus the classic surgical procedures commonly used in the clinic., Results: A total of 7 studies involving 592 patients were included. The combined data showed that TUSP can shorten the operation time [MD: -33.68; 95% CI: - 38.45 to - 28.91; P < 0.001], reduce intraoperative blood loss [MD: -56.06; 95% CI: - 62.68 to - 49.43; P < 0.001], shorten the time of indwelling catheter [MD: -1.83; 95% CI: - 1.99 to - 1.67; P < 0.001], shorten the postoperative hospital stay length [MD: -1.61; 95% CI: - 1.90 to - 1.32; P < 0.001] and improved postoperative quality of life score (QOL) [MD: 0.16; 95% CI: 0.02 to 0.29; P = 0.02] compared to traditional surgical approaches. There were no statistically significant differences in international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), residual urine volume (RUV), or complications between TUSP and traditional approached., Conclusion: TUSP can be an effective alternative for clinical treatment of benign prostatic hyperplasia. Given the limitations of the included studies, more high-quality randomized controlled trials are needed in the future to validate or update the results of this analysis.

Background: Since the implementation of robotic surgery, the platforms have been updating constantly in terms of arm configuration, tool design, scope settings, and the number of trocars placed. The introduction of new robotic technology is challenging and requires studies followed by technique adaptions., Objective: This study aims to report a logical and technologically safe approach to the learning curve using the da Vinci single-port (SP) console and describes our robotic-assisted radical prostatectomy (RARP) technique step by step., Design, Setting, and Participants: A prospective study from 26 consecutive patients who underwent RARP with the da Vinci SP console from June to August 2019., Surgical Procedure: All surgeries were performed with a transperitoneal technique; one robotic trocar was placed above the umbilicus and one additional 12 mm trocar was placed in the right lower quadrant., Measurements: We described the step-by-step technique and reported the perioperative and pathological data. In addition, we considered the hospital length of stay and pain scale following surgery. Continuous variables were reported as median and interquartile ranges. Categorical variables were reported as frequencies and proportions., Result and Limitations: The total median operative time was 121 min, console time was 85 min, and blood loss was 50 ml. No complications were reported. In the final pathology, four patients had Gleason 6, 20 had Gleason 7, one had Gleason 8, and one had Gleason 9.Of the patients, 70% were ≤pT2 and 30% were ≥pT3a. Only 11% had positive surgical margins. This study is limited by the small number of patients and a short period of follow-up to evaluate functional and oncological outcomes of this new technology., Conclusions: RARP with the da Vinci SP is feasible and safe. Therefore, the step-by-step technique described in this study could be considered an option to perform radical prostatectomies. However, we still need better-designed studies to compare the outcomes with those of the multiport platform., Patient Summary: We reported our step-by-step technique describing a safe approach to robotic-assisted radical prostatectomy during the transition from the Xi to the da Vinci single-port robot., (Copyright © 2020. Published by Elsevier B.V.)

Robotic-assisted simple prostatectomy (RASP) has emerged as a safe and effective treatment option for symptomatic patients with lower urinary tract symptoms related to significant benign prostatic enlargement (BPE) above 80 g. The recent release of the da Vinci SP robotic system (Intuitive, Sunnyvale, CA, USA) continues to advance the minimally invasive nature of robotic surgical technology. We now report our institution's initial experience performing RASP using the da Vinci SP robotic system. An IRB-approved, retrospective chart review was performed of all patients undergoing robotic-assisted simple prostatectomy using the da Vinci SP surgical system in the treatment of benign prostatic enlargement by a single surgeon from March to June 2019. Pre-operative, intraoperative, and post-operative data were collected for descriptive analysis. A total of 10 men, mean age of 69 ± 4 years, with mean prostate volume of 104 ± 11 g underwent surgery. The robotic cannula and a single assistant port were utilized in all cases. No cases required conversion to a multi-port robotic platform or open approach, nor required the placement of additional assistant ports. No intraoperative or immediate post-operative complications were noted. Mean estimated blood loss was 141 ± 98 mL and operative time was 172 ± 19 min. Mean catheter time was 1.9 ± 1.8 days. One patient reported transient de novo stress urinary incontinence. Single-port RASP is a safe and effective intervention for BPE. The smaller surgical footprint from the device appears to make earlier catheter removal possible. Comparative evaluation with multi-port RASP and other modalities is warranted.

Introduction: Holmium laser enucleation of the prostate (HoLEP) has become an increasingly common surgical management option for treatment of symptomatic benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) has long been considered the gold standard, contemporary literature and newer guidelines indicate that HoLEP has become the new size-independent endoscopic gold standard for surgical BPH treatment., Materials and Methods: We provide a review and update on current HoLEP surgical techniques, outcomes, safety, and durability according to the growing body of literature., Results: The current body of literature and guidelines indicate HoLEP as a safe and effective surgical treatment for symptomatic BPH regardless of prostate size. Durable long term subjective and objective outcomes have been demonstrated in previous studies, extending beyond 10 years., Conclusions: HoLEP continues to demonstrate durable long term efficacy for treating patients suffering from lower urinary tract symptoms (LUTS) due to BPH. The American Urological Association (AUA) guidelines recommend its use as a size-independent endoscopic treatment option. HoLEP has proven itself to be the new gold standard in surgical treatment for LUTS secondary to BPH with the ability to endoscopically treat prostates independent of size, with durable long term outcomes.

Objective: To present our initial experience with single-port percutaneous transvesical simple prostatectomy using the novel SP robotic surgical system., Methods: Ten patients underwent single-port transvesical simple prostatectomy between February and November 2019. Percutaneous access to the bladder dome was made and all SP instruments were inserted through the SP multichannel cannula directly into the bladder. Prostate adenoma enucleation, hemostasis and trigonization were done according to the principles of open simple prostatectomy technique. Demographics and perioperative outcomes were prospectively collected and analyzed., Results: All procedures were performed successfully without the need for conversion to open surgery. Median preoperative estimated prostate size was 159 (Interquartile range (IQR) 108-223) grams. No intraoperative complications occurred. Median operative time and estimated blood loss were 190 (IQR 146-203) minutes and 100 (IQR 68-175) ml, respectively. Mean postoperative specimen weight was 84.3 ± 34 grams. Median length of hospital stay was 19 (IQR 17-28) hours. All patients were satisfied with their urinary flow after catheter removal without any episode of acute urinary retention 1-6 months, postoperatively., Conclusion: Single-port transvesical simple prostatectomy can be offered as an alternative treatment option for surgical management of lower urinary tract symptoms associated with large prostate adenoma. Sparing the peritoneal cavity, minimum dissection of the bladder, excellent visualization of the prostate fossa can be some of the potential advantages of this minimally invasive approach. Comparative studies with standard techniques are advisable to evaluate the surgical outcome and postoperative morbidity of each treatment modality., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: We compared intraoperative and perioperative outcomes between extraperitoneal and transperitoneal radical prostatectomy performed using a "purpose-designed" single port robotic platform., Materials and Methods: A total of 98 patients underwent single port robotic prostatectomy using the da Vinci SP® robotic system with extraperitoneal (group I, 52) vs transperitoneal (group II, 46) approach. Demographics and perioperative data including postoperative recovery outcomes were recorded and compared between the 2 groups., Results: Groups were similar in terms of demographics and prostate cancer risk category. Mean operative time (201±37.5 vs 248.2±42.3 minutes, p <0.00001) as well as median postoperative hospital stay (4.3 vs 25.7 hours p <0.0001) was significantly shorter with the extraperitoneal approach. Overall need for pain medications or narcotics as well as the required amount of narcotics per patient (if administered) were significantly lower with the extraperitoneal approach. Extraprostatic extension was detected in 48.1% vs 41.3% of patients in groups I and II, respectively. Surgical margins were positive in 26.9% in group I vs 41.3% in group II (p=0.13). More than 80% of patients with positive surgical margins had high risk features on final surgical pathology. The 90-day continence rate was similar between the 2 groups (60% vs 62.5%, p=0.82)., Conclusions: Extraperitoneal and transperitoneal single port robotic radical prostatectomy are safe and feasible approaches. The extraperitoneal approach is associated with a significantly shorter postoperative hospital stay and decreased need for postoperative narcotics. Randomized trials with adequate sample size and postoperative followup are advisable for further evaluation of the outcomes to clarify patient selection criteria for each approach.

Objective: To compare perioperative and post-operative outcomes for holmium laser enucleation of the prostate (HoLEP) between cases performed with a 550 µm or 1000 µm fiber., Methods: We retrospectively reviewed the most recent 50 patients undergoing HoLEP with a 550 µm fiber and the most recent 50 patients with a 1000 µm fiber. The length of exposed laser fiber after stripping was measured pre- and post-enucleation, with the difference being our primary outcome of degradation length. We compared operative and clinical characteristics between patients undergoing HoLEP using 550 and 1000 µm laser fibers., Results: All 100 patients met inclusion for analysis. Overall, the 550 µm fiber experienced more degradation than the 1000 µm fiber (2.9 vs 1.9 cm, respectively; p = 0.01). The 1000 µm fiber utilized significantly less energy compared to the 500 µm fiber (81 vs 109 kJ, respectively; p < 0.01). In addition, operations performed with the 1000 versus the 500 µm fiber were overall shorter (79 vs 88 min, respectively; p = 0.03), although both groups had statistically similar times for enucleation (45 vs 51 min, respectively; p = 0.42) and morcellation (10 vs 9 min, respectively; p = 0.50). These findings occurred in the context of statistically similar prostate weight enucleated and bladder stones treated between groups. Post-operatively patients experienced no difference in blood loss or dysuria., Conclusions: Use of the 1000 µm fiber resulted in significantly less fiber degradation, energy requirement, and total operative time during HoLEP, in spite of similar prostate size and time required for enucleation and morcellation. Different fiber diameters do not appear to affect post-operative blood loss or dysuria.

Objective: To evaluate the efficacy and safety of 1470-nm Diode Laser Enucleation of the Prostate (DiLEP) in patients with benign prostatic hyperplasia continuously receiving oral anticoagulants or antiplatelet drugs., Methods: From January 2016 to June 2017, 144 patients were submitted to 1470-nm DiLEP, including 49 (34.0%) continuously administered anticoagulants or antiplatelet drugs per os due to cardiac and/or cerebrovascular diseases (group A), while 95 (66.0%) were not (group B). Evaluation was performed preoperatively, and at postoperative 3, 6, and 12 months, respectively. Patient baseline features, operative data, perioperative complications, and postsurgical outcomes were assessed., Results: Both groups had comparable preoperative parameters, except age (77.3 ± 7.5 vs 73.2 ± 8.8 years, P = .007). Meanwhile, surgical time, sodium decrease, catheterization duration, and hospital stay markedly differed between the 2 groups. In comparison with group B, group A patients had statistically higher blood loss (14.9 ± 7.3 g/L vs 10.2 ± 7.0 g/L, P < .001) and increased bladder irrigation time (21.1 ± 10.9 hours vs 16.1 ± 9.0 hours, P = .004). One case required blood transfusion in group A, because of moderate anemia preoperatively. Both groups showed similar blood transfusion and complication rates. International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual were markedly improved in both groups at 3-, 6-, and 12-month follow-up postoperatively compared with baseline values. However, no statistically significant differences were observed between the 2 groups in various assessment parameters at follow-up (P > .05)., Conclusion: These findings demonstrated that 1470-nm DiLEP is efficient and safe in benign prostatic hyperplasia cases receiving continuous oral anticoagulant or antiplatelet drugs. Anticoagulation therapy did not significantly influence the results and complication rates., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To determine if preoperative catheter dependence or specimen weight is associated with failed trial without catheter (TWOC) following holmium laser enucleation of the prostate (HoLEP)., Material and Methods: The study population consisted of 143 consecutive men who underwent HoLEP by a single surgeon over 10 months. Ten were excluded from analysis because they did not have a TWOC on the morning following surgery. Preoperative catheter dependence and specimen weight as well as catheter reinsertions were analyzed., Results: Of 133 men included in analysis, 23 (17.3%) required catheter reinsertion. Of the 23 requiring catheter reinsertion, 6 were catheter dependent preoperatively and 17 were not. Men who were catheter dependent had a lower overall rate of failed TWOC compared to those who were not catheter dependent (15.0% vs 18.3%, P = .647). Mean specimen weight for men requiring catheter reinsertion was significantly lower than men who passed their TWOC (49.9 gm vs 73.1 gm, P = .013)., Conclusion: Very few studies exist on factors associated with short-term catheter reinsertion following HoLEP or other prostatic hyperplasia procedures. We hypothesized that preoperative catheter dependence and small specimen weight would predispose to catheter reinsertion. Specimen weight was inversely related to risk of catheter reinsertion after HoLEP and preoperative catheter dependence was not associated with catheter reinsertion. In men with small prostates, consideration should be given to delayed TWOC to allow resolution of capsular edema and accumulation of clot in the prostatic fossa. Transition zone volume below which delayed TWOC should be considered is the subject of future studies., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS)., Methods: HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared., Results: A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Q max , and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P <.05). At 1-year follow-up, no statistically different change in Q max , PVR, or IPSS score was noted between the 2 groups., Conclusion: Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS., (Copyright © 2020 Elsevier Inc. All rights reserved.)