Urology Research Articles

Differences in lasers and laser technologies: what does a clinician need to know?

This review focuses on recent advancements in laser technologies used in urology, particularly in enucleation, vaporization, lithotripsy, and focal laser ablation (FLA). The growing use of the thulium fiber laser (TFL) and the development of pulsed thulium lasers (p-Tm:YAG) highlight the relevance of this review, as these innovations aim to improve precision and outcomes in urological procedures. Recent studies have shown the advantages of TFL in achieving precise tissue ablation, reduced retropulsion offered by the Moses technology in holmium lasers, and the potential of pulsed thulium lasers for more precise control of the effects on tissues. Additionally, FLA is gaining traction for its ability to treat localized prostate cancer with minimal collateral damage. These technologies not only optimize procedural accuracy but also reduce complications, making them safer for high-risk patients, including those receiving anticoagulants. The advancements in laser technology, including TFL, Moses technology, and pulsed thulium lasers, are improving outcomes in urological surgeries by increasing precision, reducing operative time, and minimizing complications. FLA represents a promising alternative for minimally invasive cancer treatments. Ongoing research should focus on optimizing laser parameters and exploring broader clinical applications.

Surgical Opioid Stewardship: From the Epidemic Through the Pandemic and Beyond.

In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond. From September 2019 through August 2023, 15 NSQIP hospitals in two states gathered opioid-specific variables on patients undergoing 12 procedures. Operations were performed by seven specialties including general surgery, gynecology, orthopedic surgery, neurosurgery, surgical oncology, urology, and vascular surgery. Data were gathered on preoperative opioid use, intraoperative opioids and blocks, opioid avoidance strategies and discharge opioid prescriptions. Cochran-Armitage trend and Wald tests were utilized to assess temporal effects with p values <0.001 considered significant. Among 18,325 patients who underwent surgery, 54% were women, with a median age of 60 years. The percentage of patients taking opioids preoperatively decreased significantly (p<0.001) in the overall cohort from 17% to 10%. The utilization of intraoperative blocks also increased significantly (p<0.001) among all patients from 21% to 27%. The utilization of opioid avoidance strategies was maintained in the majority of the patients (68-70%) and the percentage of postoperative opioid prescriptions on discharge remained the same (81%) over the four-year study period. From 2019 to 2023, the percentage of patients taking opioids preoperatively decreased significantly, and the utilization of intraoperative blocks also increased significantly. The PENNJ-SOS program played a key role in combatting the opioid crisis over the four years of data collection, adapting effectively to the challenges posed by the Coronavirus Disease 2019 pandemic.

Comparative evaluation of venous thromboembolic risk in urologic inpatients using different risk assessment models

Introductions: The process of determining thromboprophylaxis decisions in urologic surgery entails assessing the risk of venous thromboembolism (VTE) in comparison to the risk of bleeding. Risk assessment models (RAMs) have been created to systematically calculate an individual’s risk of VTE. In our study, we evaluated the risk of VTE in urologic inpatients using two RAMs specifically designed for urology by the European Association of Urology (EAU) and the American Urological Association (AUA), the Caprini score, and the CHA2DS2-VASc score. Methods: The study group consisted of 236 inpatients within the urology department. Data from medical records included information on various factors, such as age, gender, body mass index, personal and family history of the patients. The risk of VTE was determined using the RAMs provided by EAU and AUA, the Caprini score, and the CHA2DS2-VASc score. Results: Chemical prophylaxis was advised for 48 (35.3%) patients according to the EAU model, 47 patients (34.6%) according to the AUA model, 128 (94.1%) patients based on the Caprini score, and 80 (58.8%) patients according to the CHA2DS2-VASc score. Limitations of the study include a small sample size and lack of post-surgery venous thromboembolic events recording. Conclusions: The VTE RAMs developed by the EAU and AUA provide consistent recommendations for thromboembolism prophylaxis in urologic patients, while the Caprini model's strict adherence may lead to excessive prophylaxis recommendations. The EAU approach is user-friendly but urologists must judiciously weigh bleeding and VTE risks on an individual basis, ensuring optimal prophylaxis use.

Assessing Perioperative Anesthesia Safety in Urological Surgeries: A Comprehensive Study of Critical Incidents

Assessing Perioperative Anesthesia Safety in Urological Surgeries: A Comprehensive Study of Critical Incidents

European System for Cardiac Operative Risk Evaluation II and Liver Dysfunction.

Background: The importance of liver dysfunction in predicting mortality in patients undergoing cardiovascular surgery is an important topic due to the general desire to improve current risk scores such as EUROSCORE II (European System for Cardiac Operative Risk Evaluation), with EUROSCORE III being currently under development. The model for End-Stage Liver Disease (MELD) Score has already proven its utility in predicting outcomes for patients undergoing abdominal, cardiovascular or urological surgery. In the present study, we want to see its usefulness in proving the postoperative mortality in patients undergoing coronary artery bypass surgery. Methods: This was a retrospective study, and it included 185 patients, with 93 survivors being randomly chosen from a total of 589 surviving patients using age, emergency and the weight of cardiac procedures as criteria to match the 92 deceased patients during hospitalization in the postoperative period who underwent coronary artery bypass grafting (CABG) alone or CABG and other concomitant cardiovascular interventions during a 10-year period of time. We calculated for all these patients, at the time of admission, the MELD Score and EUROSCORE II, and we analyzed the predictive performance of the two scores and their constituents. Results: In the multivariable model, patients with a MELD Score ≥ 5.54 had a 2.38-fold increased risk of death (95% C.I.: 1.43-3.96, p = 0.001), while those with a EUROSCORE ≥ 10.37 had a 8.66-fold increased risk of death (95% C.I.: 3.09-24.29, p < 0.001). After combining the two scores, the conditional scenario achieved a high overall accuracy of 84.32% (p < 0.001) in predicting mortality. Conclusions: Patients with a MELD Score ≥ 5.54, had good sensitivity and a very good specificity in terms of mortality prediction, but the conditional scenario, leveraging both risk scores, i.e., the MELD Score and EUROSCORE, offers the highest utility in terms of enhancing mortality prediction regarding these patients.

Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer

Active surveillance in men with less aggressive prostate cancer is inconsistently used despite clinical guidelines. Renumeration generally favors treatment over conservative management and may contribute to the variable adoption of active surveillance, which suggests that value-based payment incentives may promote guideline-concordant care. To describe the adoption of active surveillance in low-risk prostate cancer, following the initiation of a novel payment incentive sponsored by a commercial payer to support its use. This cohort study included men with prostate cancer diagnosed between 2015 to 2021 with data registered with the Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide quality-improvement collaborative of practicing urologists. Eligible participants were men with newly diagnosed low-risk or low-volume, favorable intermediate-risk prostate cancer who were eligible for active surveillance. Data were analyzed from January 2015 through December 2021. Health insurance payment incentive established between June 9, 2017, and September 30, 2018, to encourage active surveillance adoption within MUSIC. Upon meeting the target (ie, at least 72% of men with low-risk disease consider or initiate surveillance), the insurer would provide enhanced reimbursement on claims covered by preferred provider organization plans independent of diagnosis. Active surveillance adoption relative to the preincentive period among men with low-risk prostate cancer. Secondary analyses examined practices by baseline surveillance use and proportion of patients with eligible insurance plans, as well as patients with favorable intermediate-risk disease. We identified 15 273 patients (median [IQR] age, 65 [59-70] years), of whom 10 457 (68.5%) had low-risk disease. The percentage of these men electing for surveillance increased, from 54.4% in 2015 (729 of 1340 men) to 84.1% in 2021 (1089 of 1295 men). Relative to the preincentive period, the payment incentive was not associated with increased surveillance use among patients with low-risk disease (odds ratio [OR], 0.96; 95% CI, 0.75-1.24) during its application. Secondary analyses similarly did not demonstrate an association between the payment incentive and active surveillance adoption. A payment incentive was not associated with increased active surveillance adoption in men with low-risk prostate cancer relative to the preincentive period. Value-based reimbursement incentives may require tailored implementation that considers existing reimbursement policy and practice characteristics to improve prostate cancer care quality.

Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-Resource Settings: A Scoping Review

Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-Resource Settings: A Scoping Review

The influence of positive and negative intraoperative feedback in laparoscopic simulation in pediatric urology training.

This study aimed to explore the impact of positive or negative feedback on the performance of trainees in pediatric urology during simulation exercises in pediatric laparoscopy. Twenty-five students enrolled in a national Pediatric Urology Laparoscopy Simulation participated in the study. They performed the Fundamentals of Laparoscopic Surgery (FLS) skills, specifically peg-transfer and intracorporeal knot-tying, in a randomized study design while receiving positive or negative feedback from an attending pediatric urologist. On the first day, all students performed FLS peg-transfer and intracorporeal knot-tying tasks on a pediatric laparoscopic simulator. On the second day, students were randomized to receive either positive or negative comments during the procedure. Task performances, measured by task time and errors, was compared between both groups. Statistical analysis was conducted using the Mann-Whitney U test. The difference in execution time between exercises with and without feedback was significantly greater in the group that received negative feedback compared to the group that received positive feedback (p=0.003). Students who received positive feedback increased their time by a median of 2s, whereas students who received negative comments increased their time by a median of 34s. Feedback should be delivered in a manner that is supportive, respectful, and improvement-focused rather than discouragement. Understanding these dynamics can guide the development of effective feedback strategies to optimize learning and enhance performance outcomes in training for minimally invasive surgery in pediatric urology.

Fertility preservation and infertility treatment in female surgical trainees in Alberta: A survey of trainee knowledge, attitudes, and needs

ObjectiveTo describe fertility knowledge and views on family planning and fertility preservation/treatment among female surgical trainees in Alberta. MethodsA voluntary, anonymous online survey was sent to surgical program coordinators in Alberta to forward to their respective trainees. Participants included surgical trainees from cardiac surgery, general surgery, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopedics, otolaryngology, plastics, urology, and vascular surgery. Questions assessed demographics, fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment. The primary outcome was the needs of trainees regarding fertility preservation/treatment. Secondary outcomes included fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment. ResultsThe survey had a 71.8% response rate, with 125 responses analyzed. The median score for fertility knowledge was 3/6. Most trainees (84.8%) were childless, with 68.0% citing career impact as a significant factor in delaying childbearing. Career aspirations, training duration, and long work hours were identified as top factors impacting family planning. Only 3.2% had undergone oocyte cryopreservation, while 48.0% had considered it. Awareness of oocyte cryopreservation options and insurance coverage was low. 57.6% of trainees had received no counseling about family planning during their training. ConclusionFemale surgical trainees in Alberta face significant fertility concerns, exacerbated by gaps in fertility knowledge and career demands delaying childbearing. There is strong interest in fertility preservation, but barriers include lack of awareness, financial constraints, and inadequate counseling. Enhanced education, counseling, insurance coverage, and supportive policies are needed to support trainees' reproductive and career goals.

Renal Mass Biopsy Is Associated With Fewer Radical Nephrectomies for Benign or Indolent Disease, Particularly for T1b Renal Masses.

How renal mass biopsy (RMB) impacts patient management with T1 renal masses (T1RMs) is unclear. We explore the association between RMB and utilization of active surveillance (AS), nephron-sparing interventions, and radical nephrectomy (RN). Data were analyzed retrospectively using the MUSIC-KIDNEY (Michigan Urological Surgery Improvement Collaborative Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy) registry. Treatment received was analyzed using a fitted mixed-effects multinomial logistic-regression model. Of 4062 patients, 19.6% underwent RMB. Factors associated with RMB included younger age, higher Charlson comorbidity score, tumor size > 2.0 cm, and higher complexity tumors. AS was selected by 88%, 68%, and 27% of patients with benign, indeterminate, and malignant RMB findings. Nonmalignant pathology at surgery was significantly (P < .0001) more common without RMB (vs after RMB), ie, 14.8% vs 7.2% of PN and 10.2% vs 1.7% of RN. In patients with T1bRM managed without vs with RMB, AS was chosen by 22% vs 34%, nephron-sparing interventions by 31% vs 35%, and RN by 47% vs 32% (P = .0027). An interaction between tumor stage (T1a vs T1b) and RMB remained in multivariable analyses accounting for practice-level variation and other confounding variables. The risk-adjusted RN rate for T1bRM was 41.4% without RMB vs 27.8% with RMB; 7.4 RMBs are needed to avoid 1 RN (number needed to treat) for benign or indolent disease. Treatments received by T1RM patients undergoing RMB are different than when RMB is omitted, based on RMB results and several confounders. T1RM patients benefit from reduction in intervention for nonmalignant disease, particularly when RN is planned. For every 7 biopsies of T1bRM performed, 1 RN was avoided.

Reply to Editorial Comment on"Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery".

Reply to Editorial Comment on"Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery".

Trends and Outcomes in Reporting and Grading Complications of Urological Surgery: A Retrospective Analysis

Introduction: Complications in urological surgery can range from minor, self-limiting issues to severe, life-threatening events requiring significant medical intervention. This study aimed to assess the reporting and grading of complications in urological surgery, focusing on current trends and future perspectives. Methodology: Conducted at the Institute of Kidney Diseases, Peshawar, from 2022–2023. This retrospective study included 165 patients diagnosed with vesicovaginal fistula (VVF) or bladder urethral stricture and hypoplasia (BURSH) requiring surgical intervention. Patients with prior surgeries that could interfere with complication assessment or incomplete medical records were excluded. Results: Various surgical procedures were performed, tailored to the individual’s medical history, fistula location, and size. Surgical approaches included transvaginal repair, transabdominal repair, or laparoscopic repair. The mean age of patients was 49.23 years (range 26–74), with 90% females and 10% males. Comorbidities included diabetes (20%), hypertension (25%), and other chronic illnesses (15%), with an average BMI of 24. A history of smoking and alcohol consumption was reported in 15% and 10% of patients, respectively, while 30% had undergone prior urological surgeries. Discussion: Post-surgery, 70% achieved satisfactory urinary control, 20% experienced mild to moderate incontinence, and 10% reported persistent control issues. Minimal to moderate pain was noted in 60%, while 25% experienced transient discomfort resolving within three months, and 15% reported chronic pain. Conclusion: The findings highlight the importance of personalized surgical approaches, with minimally invasive techniques reducing complication rates and improving outcomes in urological surgeries for VVF and BURSH.

Global trends and hotspots in robotic surgery over the past decade: a bibliometric and visualized analysis.

Since its introduction, robotic surgery has experienced rapid development and has been extensively implemented across various medical disciplines. It is crucial to comprehend the advancements in research and the evolutionary trajectory of its thematic priorities. This research conducted a bibliometric analysis on the literature pertaining to robotic surgery, spanning the period from 2014 to 2023, sourced from the Web of Science database. The objective was to delineate the publication trends and trace the development of research topics within the domain of robotic surgery. From 2014 to 2023, there has been a consistent upward trend in the annual volume of publications concerning robotic surgery. The United States emerges as the leading country in terms of both the number of publications (n=3402) and citations (n=57731). The Journal of Robotic Surgery has the highest number of publications (n=506), while IEEE Transactions on Robotics has the highest number of citations (n=53). Yonsei University is the institution with the greatest number of publications (n=196), and the University of Washington has the highest average citation count (n=30). Alexandre Mottrie is the author with the most publications and citations (n=70 publications, n=1816 citations). Keyword analysis revealed seven distinct clusters: (1) applications and techniques of robotic surgery; (2) urological surgery and associated complications; (3) gastrointestinal diseases and surgical interventions; (4) robotic thyroid surgery and related complications; (5) gynecological diseases and corresponding surgical procedures; (6) Da Vinci robot and its training; (7) pulmonary diseases and associated surgeries. Artificial intelligence (AI) has been identified as a newly emerging keyword in the field. The corpus of literature on robotic surgery has seen a steady rise over the past decade, marked by extensive collaboration among various countries, institutions, and researchers. This study has delineated the global trends, identified research hotspots, highlighted emerging topics, and outlined the foundational knowledge within the field of robotic surgery. Looking forward, the integration of AI with robotic surgery is poised to offer substantial benefits and is anticipated to become a pivotal trend and area of focus in the field's future advancement.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey.

Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. This study aimed to understand families' perspectives regarding their children's surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model. Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child's surgical experience. In total, 91% (453/500) of enrolled families completed at least 1 postoperative survey; 53% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 66% (160/242) being male. Patients underwent orthopedic (60/242, 25%), urological (39/242, 16%), general (36/242,15%), otolaryngological (31/242, 13%), ophthalmological (32/242, 13%), dental (27/242, 11%), and plastic (17/242, 7%) surgeries. Largely positive comments (398/485, 82%) were made on the recovery and clinical care experience. A key theme for improvement included "communication," with subthemes highlighting parental concerns regarding the "preoperative discussions," "clarity of discharge instructions," and "continuity of care." Other themes included "length of stay" and "recovery experience." Feedback also suggested survey design amendments for future iterations of this instrument. Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families.

Bladder Cancer Highlights on UROPEDIA, Which is an E-Learning Platform of The Society of Urological Surgery in Turkiye

Bladder Cancer Highlights on UROPEDIA, Which is an E-Learning Platform of The Society of Urological Surgery in Turkiye

Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience

ABSTRACT Background and objectives The widespread utilization of robotic surgeries in urology encouraged several teams to explore the option of performing robot-assisted partial nephrectomy (RAPN), taking advantage of its magnified stereoscopic vision and the articulating instruments that facilitate tumor resection and the reconstructive steps of hemostasis and renorrhaphy. The implementation of the CMR Versius system in RAPN, especially in complex masses, has not been explored yet. Herein, we present our initial experience in performing RAPN in complex renal masses using this novel platform. Methods Between July 2022 and November 2023, thirty patients who had complex renal masses and were candidates for RAPN were enrolled in this study. Tumor complexity was assessed using the preoperative aspects of the dimension used for anatomic (PADUA) nephrometry scores. Perioperative data were prospectively collected and analyzed. ‘TRIFECTA’ was defined as free surgical margins, warm ischemia time (WIT)< 30 minutes, and no major complications (>Clavien-Dindo II). Results All cases were successfully completed with no conversion to radical, open, or laparoscopic surgery. The median PADUA score was 9.5 (8–11). The mean docking time, console time, and total operative time were 9.17 ± 0.91, 149 ± 14.27, and 177.17 ± 29.53 minutes, respectively. The mean WIT was 26.67 ± 3.66 minutes. Surgical margins were free in all cases. TRIFECTA was fulfilled in 25/30 patients (83.33%). Five patients (16.66%) did not fulfill TRIFECTA; two patients had prolonged WIT > 30 minutes, two had prolonged WIT with prolonged urine leakage necessitating DJ stent insertion, and the fifth patient had only prolonged urine leakage and DJ insertion. None of the patients developed tumor recurrence or acute kidney injury during follow-up. Conclusion Performing RAPN with the CMR Versius platform is a feasible option in complex renal masses with slightly increased but accepted WIT and total operative time. It should be wisely restricted to well-experienced teams.

Risk factors for benign uretero-enteric anastomotic strictures after open radical cystectomy and ileal conduit.

Radical Cystectomy (RC) is one of the most common and complex surgical procedures in urologic surgery, and benign ureteroenteric anastomosis strictures (UAS) are complications described in about 15% of patients undergoing RC with different urinary diversion (UD). The aim of this study is to evaluate and analyze risk factors related to the development of ureteral stenosis after RC. All consecutive patients who underwent RC with ileal conduit from December 2019 to December 2022 were included. According to the guidelines patients with hydronephrosis were investigates with CT-scan or Ultrasound and blood tests at 3-6-12 months and then early. UAS was confirmed with CT-scan and eventually treated with nephrostomies with (with or without descendent pyelography). Several potential risk factor releated to UAS were analyzed by univariate analysis including preoperative, intraoperative and postoperative variables. In total 116 patients were included. At 30 months mean follow up, 21 patients (19%) were diagnosed with UAS. Median time from RC to diagnosis of benign UAS was 6 months (IQR: 4-9). At the univariable analysis previous abdominal surgery (OR 13.5 CI 3.4-63.4, p < 0.001) had the strongest association with shorter time to stricture development and six-fold highest risk of UAS development (OR 6.41, IC 95%; 2.16-21.1, p < 0.001). Also, gender, age, body mass index, lower albumin serum level, higher fibrinogen serum level showed statistically significant association (p < 0.05). Patients with preoperative lower albumin serum level, lower albumin/fibrinogen ratio and higher fibrinogen level are more likely to develop UAS. Moreover, having a history of PAS significantly increases the risk of strictures formation.

Current Feasibility of Urologic Telesurgery in Low/Middle Income Countries

It is estimated that nearly five billion people do not have access to surgical care. Approximately 94% of individuals in low- and middle-income countries (LMICs) lack access to surgery in comparison to 14.9% in high-income countries (HICs). There are several urologic conditions requiring surgical intervention that are not treated because of the limited number of expert urologists in LMICs. Telesurgery is a concept that connects patients and surgeons in different locations through the use of a robotic surgery system. In this review, we explain the origins of telesurgery as well as the benefits and obstacles to its global implementation. Telesurgery can reduce travel times and the dangers associated with traveling for surgical care in LMICs. Additionally, telesurgery allows patients in LMICs to gain access to expert urologists while also providing effective training to upcoming surgeons. However, LMICs require substantial investment to improve digital infrastructure that will support urologic telesurgery. There will also be ethical, legal, and policy considerations that will need to be resolved for safe and equitable urologic telesurgery to occur. There have been multiple successful applications of urologic telesurgery, suggesting that the technology for this to become routine is already available. The time for international collaboration must begin now to reduce global disparities in access to urologic surgery.

Comparative evaluation of SanAgileTMSA01 ultrasonic scalpel and Johnson & Johnson GEN11, and HAR36 for efficacy and safety

ABSTRACT Background The advent of ultrasonic scalpels has remarkably advanced minimally invasive surgery; however, the Chinese market’s reliance on imports highlights the urgent need for a cost-effective, efficient, and domestically produced surgical scalpel. This study aimed to compare SanAgileTMSA01 with the Johnson & Johnson GEN11, and HAR36 surgical devices. Research design and methods In total, 152 participants requiring urological or general laparoscopic surgery were randomly and equally divided between the two hospitals and randomized to the test and control groups. Clinical outcomes, adverse event rates, intraoperative bleeding, and surgery duration were compared between the two devices. Results The clinical application rate of both devices was 100%. There were no significant differences between the two groups in intraoperative bleeding, surgery duration, and incidence of adverse events. In the test group, five device-related adverse events occurred (6.58%), compared to two (2.63%) in the control group (no significant difference). The device-related adverse events did not result in any sequelae. Conclusions The clinical performance of the SanAgileTMSA01 was comparable to that of the Johnson & Johnson GEN11 and HAR36. The SanAgileTMSA01 device may serve as a viable alternative ultrasonic surgical tool, thereby providing clinicians with additional options. Trial registration Registration number of Shanghai Medical Equipment Preparation 20,190,114