OBJECTIVE:To assess adherence of self-labelled proficiency-based progression (PBP) studies to evidence-based PBP criteria and examine associations with training outcomes. METHODS:A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews. PubMed, CENTRAL, EMBASE, MEDLINE, and Scopus were searched from inception to 1 March 2023. Prospective English-language studies on healthcare procedural training reporting objective performance outcomes were included; non-prospective, non-quantitative, non-procedural, non-English studies, and reviews were excluded. Pre-specified outcomes included adherence to 18 evidence-based PBP criteria and objective performance metrics (errors, steps, time); secondary outcomes included proficiency benchmark achievement and Likert ratings. Data extraction was performed independently by multiple reviewers. Study quality was assessed using the Medical Education Research Study Quality Instrument and risk of bias by two investigators. Effect sizes were pooled using random-effects models (DerSimonian-Laird), expressed as the ratio of means (ROM) for continuous outcomes and bias-corrected odds ratios for dichotomous outcomes. RESULTS:Of 646 studies identified 175 met inclusion criteria. In the PBP studies (n = 18), 94% fulfilled minimum criteria (use of a proficiency benchmark, its quantitative definition, and requirement for demonstration prior to progression) vs 36% of non-PBP studies (n = 157). If all PBP criteria were included, 83% of PBP studies used these criteria vs only 2% of non-PBP-studies. In quantitative analysis (27 randomised clinical studies, 761 participants), ROM results showed that PBP training reduced the number of performance errors by 58% (P < 0.001) and procedural time by 28% (P = 0.006), increasing number of steps performed by 22% (P = 0.03). When stratified based on number of criteria fulfilled, meta-regression demonstrated that increasing the number of PBP criteria fulfilled was associated with progressive and systematic trainee performance improvement. CONCLUSIONS:The more training methodologies adhere to established PBP criteria, the better training outcome will be.

Abstract Objective The aim of this paper is to evaluate fellowship outcomes 10 years after implementation of the European Association of Urology Robotic Section (ERUS) structured curriculum for robot‐assisted radical prostatectomy (RARP), with a focus on completion rates and reasons for non‐completion. Subjects and methods Data were obtained from institutional records and a trainee survey. The primary outcome was fellowship completion (i.e., Certificate of Excellence achievement). Secondary outcomes included reasons for non‐completion and satisfaction. Completion rates were analysed annually, with trends assessed using the Cochran–Armitage test and log‐linear regression for the Estimated Annual Percentage Change (EAPC). Comparisons before and after introduction of a procedural diary (2023) and between pandemic and non‐pandemic years used Fisher's Exact Test. Results Among 126 fellows, a total of 42 (33%) completed the fellowship by achieving the Certificate of Excellence. The trainee survey achieved a response rate of 77%, supporting the representativeness of the collected data. The main barriers to fellowship completion included limited console access (49%), insufficient programme duration (20%), logistical difficulties (20%) and COVID‐19‐related disruptions (11%). Despite these limitations, overall satisfaction with the fellowship was high (83%), with particularly strong approval of the ORSI hands‐on training week (100%). Completion rates demonstrated a progressive increase over time, rising from 20% in 2018 to 52% in 2023. The Cochran–Armitage test confirmed a statistically significant upward trend in completion rates over the study period ( p < 0.001), while log‐linear regression analysis showed a numerical but non‐significant EAPC of 13% (95% CI –0.6 to 28.6). Although 2023 represented the highest observed completion rate, this peak was not significantly different from previous years (OR 2.63, 95% CI 0.91–7.63). Conclusions The RARP ERUS Fellowship remains a benchmark in robotic training, but unsatisfactory completion rates highlight the need for improvement. Recent reforms, including the procedural diary, show promise and warrant expansion.

Vasectomy reversal is a technically demanding microsurgical procedure aimed at restoring fertility. Robot-assisted vasovasostomy (RAVV) has been introduced to enhance precision and ergonomics, but robust clinical data remain limited. We report perioperative, functional, and fertility outcomes from one of the largest single-centre series of RAVV and explore patient-related factors associated with postoperative patency. We retrospectively analysed prospectively maintained data from men undergoing bilateral RAVV at a tertiary referral centre between January 2008 and September 2025. All patients had fathered at least one biological child before undergoing vasectomy. Perioperative outcomes, semen parameters, and pregnancy rates were assessed. Functional patency was defined as a postoperative sperm concentration ≥ 1 million/mL. Associations between clinical variables and patency were explored using univariable logistic regression analyses. Sixty men underwent RAVV. Median age at surgery was 42 years (IQR 38–47), and the median interval between vasectomy and reversal was 6 years (IQR 4–9). Median operative and console times were 118 min (IQR 100–132) and 85 min (IQR 70–100), respectively. All patients were discharged on postoperative day 1. Functional patency was achieved in 56 patients (93.3

BACKGROUND:We aimed to compare the outcomes of Robot-assisted sacrocolpopexy (RASC) performed using the novel HUGOTM Robot-Assisted Surgery (RAS) System with the Da Vinci® Xi surgical system.METHODS:Data from 38 women undergoing RASC for a ≥ 2-grade pelvic organ prolapse were collected (2021-2023).RESULTS:Overall, 23 (60.5%) and 15 (39.5%) procedures were performed using the DaVinci® Xi and the HUGOTM RAS system, respectively. The median total operative time was 123 (IQR:106.5-140.5) minutes for the DaVinci® Xi versus 120 (IQR:120-146) minutes for the HUGOTM RAS cases (p = 0.5). No conversion to open/laparoscopic surgery, perioperative complications, or system failures occurred. No differences were recorded according to day of catheter removal and length of stay.CONCLUSIONS:This study represents the first worldwide comparison of RASC executed using the HUGOTM RAS versus the Da Vinci® Xi System. Our data suggest that RASC might be performed with both robotic platforms with similar perioperative outcomes.

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 May 2024PD50-09 A NOMOGRAM TO PREDICT LYMPHNODE INVOLVEMENT IN CANDIDATES TO ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH IT3 PROSTATE CANCER ON PREOPERATIVE MULTIPARAMETRIC MRI AS UNIQUE HIGH-RISK FEATURE Carlo Andrea Bravi, Marco Paciotti, Eleonora Balestrazzi, Adele Piro, Federico Piramide, Maria Peraire, Gabriele Sorce, Claudia Colla Ruvolo, Nicola Frego, Marco Ticonosco, Mario Belmonte, Pissavini Alessandro, Silvia Rebuffo, Ruben Groote, Geert De Naeyer, Paolo Dell'Oglio, Andrea Minervini, Fabrizio Di Maida, Francesco Porpiglia, Riccardo Schiavina, Marcio Covas Moschovas, Vipul Patel, Francesco Montorsi, and Alexandre Mottrie Carlo Andrea BraviCarlo Andrea Bravi , Marco PaciottiMarco Paciotti , Eleonora BalestrazziEleonora Balestrazzi , Adele PiroAdele Piro , Federico PiramideFederico Piramide , Maria PeraireMaria Peraire , Gabriele SorceGabriele Sorce , Claudia Colla RuvoloClaudia Colla Ruvolo , Nicola FregoNicola Frego , Marco TiconoscoMarco Ticonosco , Mario BelmonteMario Belmonte , Pissavini AlessandroPissavini Alessandro , Silvia RebuffoSilvia Rebuffo , Ruben GrooteRuben Groote , Geert De NaeyerGeert De Naeyer , Paolo Dell'OglioPaolo Dell'Oglio , Andrea MinerviniAndrea Minervini , Fabrizio Di MaidaFabrizio Di Maida , Francesco PorpigliaFrancesco Porpiglia , Riccardo SchiavinaRiccardo Schiavina , Marcio Covas MoschovasMarcio Covas Moschovas , Vipul PatelVipul Patel , Francesco MontorsiFrancesco Montorsi , and Alexandre MottrieAlexandre Mottrie View All Author Informationhttps://doi.org/10.1097/01.JU.0001008620.35181.96.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients diagnosed with locally advanced prostate cancer (PCa) on preoperative MRI (iT3) are automatically included in the high-risk category. However, we previously showed that 1 in 3 patients with iT3 PCa had pT2 disease on final pathology. As such, if iT3 disease is the only high-risk feature in candidates to robot-assisted radical prostatectomy (RARP), it might mislead preoperative counseling, especially when an extended pelvic lymph node dissection (ePLND) is contemplated. Therefore, we assessed predictors of pathologic lymphnode involvement (LNI) in the largest series of men with iT3 PCa treated with RARP. METHODS: We analyzed data of 607 patients with iT3 PCa on preoperative MRI who received RARP and ePLND at five high-volume centers (2015-2020). Among them, 253 (42%) men had iT3 disease as unique feature of high-risk PCa. In this subgroup of patients multivariable regression investigated preoperative predictors of LNI on final pathology, namely preoperative PSA, biopsy ISUP grade, prostate volume on MRI, index lesion PIRADS score and diameter, location suspicious for iT3 (uni- vs. bi-lateral) and seminal vesicles involvement on MRI. The coefficients were utilized to build a nomogram for the prediction of LNI. RESULTS: Median (interquartile range [IQR]) preoperative PSA was 7.2 (5.0, 10.8) ng/ml, and 42 (17%), 106 (42%) and 105 (42%) men had biopsy ISUP group 1, 2 and 3 disease, respectively. A total of 142 (56%) patients had a PIRADS score 5 lesion, whereas the median (IQR) index lesion diameter was 1.8 (1.3, 2.9) centimeters. After surgery, a total of 40 (16%) patients had LNI on final pathology. The role of preoperative predictors was investigated on multivariable logistic regression analysis, and coefficients were utilized to build a nomogram for the prediction of LNI on final pathology (Figure 1). The area under the curve was 71% (95% confidence interval: 62%, 79%). CONCLUSIONS: In the largest series of candidates to RARP with iT3 PCa as unique high-risk feature, we developed an easy-to-use model for the prediction of LNI on final pathology. The nomogram-derived probability can help physicians to optimize surgical strategy in this subgroup of patients with preoperative imaging suggesting iT3 PCa. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1060 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlo Andrea Bravi More articles by this author Marco Paciotti More articles by this author Eleonora Balestrazzi More articles by this author Adele Piro More articles by this author Federico Piramide More articles by this author Maria Peraire More articles by this author Gabriele Sorce More articles by this author Claudia Colla Ruvolo More articles by this author Nicola Frego More articles by this author Marco Ticonosco More articles by this author Mario Belmonte More articles by this author Pissavini Alessandro More articles by this author Silvia Rebuffo More articles by this author Ruben Groote More articles by this author Geert De Naeyer More articles by this author Paolo Dell'Oglio More articles by this author Andrea Minervini More articles by this author Fabrizio Di Maida More articles by this author Francesco Porpiglia More articles by this author Riccardo Schiavina More articles by this author Marcio Covas Moschovas More articles by this author Vipul Patel More articles by this author Francesco Montorsi More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted partial nephrectomy (RAPN) is a complex and index procedure that urologists need to learn how to perform safely. No validated performance metrics specifically developed for a RAPN training model (TM) exist. A Core Metrics Group specifically adapted human RAPN metrics to be used in a newly developed RAPN TM, explicitly defining phases, steps, errors, and critical errors. A modified Delphi meeting concurred on the face and content validation of the new metrics. One hundred percent consensus was achieved by the Delphi panel on 8 Phases, 32 Steps, 136 Errors and 64 Critical Errors. Two trained assessors evaluated recorded video performances of novice and expert RAPN surgeons executing an emulated RAPN in the newly developed TM. There were no differences in procedure Steps completed by the two groups. Experienced RAPN surgeons made 34% fewer Total Errors than the Novice group. Performance score for both groups was divided at the median score using Total Error scores, into HiError and LoError subgroups. The LowErrs Expert RAPN surgeons group made 118% fewer Total Errors than the Novice HiErrs group. Furthermore, the LowErrs Expert RAPN surgeons made 77% fewer Total Errors than the HiErrs Expert RAPN surgeons. These results established construct and discriminative validity of the metrics. The authors described a novel RAPN TM and its associated performance metrics with evidence supporting their face, content, construct, and discriminative validation. This report and evidence support the implementation of a simulation-based proficiency-based progression (PBP) training program for RAPN.

We aimed to compare the outcomes of Robot-assisted sacrocolpopexy (RASC) performed using the novel HUGO TM Robot-Assisted Surgery (RAS) System with the Da Vinci ® Xi surgical system. Data from 38 women undergoing RASC for a ≥ 2-grade pelvic organ prolapse were collected (2021–2023). Overall, 23 (60.5%) and 15 (39.5%) procedures were performed using the DaVinci ® Xi and the HUGO TM RAS system, respectively. The median total operative time was 123 (IQR:106.5–140.5) minutes for the DaVinci ® Xi versus 120 (IQR:120–146) minutes for the HUGO TM RAS cases ( p  = 0.5). No conversion to open/laparoscopic surgery, perioperative complications, or system failures occurred. No differences were recorded according to day of catheter removal and length of stay. This study represents the first worldwide comparison of RASC executed using the HUGO TM RAS versus the Da Vinci ® Xi System. Our data suggest that RASC might be performed with both robotic platforms with similar perioperative outcomes.

OBJECTIVE:This study aimed to compare adverse in-hospital outcomes in ileal conduit versus neobladder urinary diversion type after radical cystectomy (RC) in contemporary versus historical patients. METHODS:Patients were identified within the National Inpatient Sample (NIS 2000-2019). Propensity score matching (PSM; 1:2 ratio) and multivariable logistic regression models (LRMs) were used. RESULTS:Of 10,533 contemporary (2011-2019) patients, 943 (9.0%) underwent neobladder urinary diversion, while 9590 (91.0%) underwent ileal conduit urinary diversion. Furthermore, of 9742 historical (2010-2019) patients, 932 (9.6%) underwent neobladder urinary diversion and 8810 (90.4%) underwent ileal conduit urinary diversion. After 1:2 PSM, within the contemporary cohort, 943/943 (100%) neobladder versus 1886/9590 (19.6%) ileal conduit patients were included. Similarly, within the historical cohort, 932/932 (100%) neobladder versus 1864/8810 (21.1%) ileal conduit patients were included after PSM. In multivariable LRMs, relative to contemporary neobladder patients, contemporary ileal conduit patients exhibited higher rates of overall postoperative (49.0 vs. 43.6%; multivariable odds ratio [MOR] 1.2), wound (4.2 vs. 2.7%; MOR 1.6), and genitourinary (13.1% vs. 10.0%; MOR 1.3) complications as well as blood transfusions (19.0 vs. 15.6%; MOR 1.3). Conversely, in multivariable LRMs within the historical cohort, no differences were recorded between ileal conduit and neobladder patients. CONCLUSIONS:Unlike historical comparisons between ileal conduit and neobladder patients, where no differences in adverse in-hospital outcomes were recorded, analyses relying on a contemporary patient cohort subject to PSM and multivariable adjustment revealed higher rates of adverse in-hospital outcomes in 4/13 examined categories. This observation should be considered at informed consent.

Background: In February 2021 Medtronic (R) (Minneapolis, MN) launched the HUGO (TM) Robot-Assisted Surgery (RAS) System in the global market. The aim of the current study is to describe the first case series and the optimal setup of robot-assisted pyeloplasty procedure, performed with HUGO RAS system in a tertiary referral robotic center. Methods: Data from consecutive patients who underwent robot-assisted pyeloplasty at Onze-Lieve-Vrouwziekenhuis Hospital (Aalst, Belgium) were recorded. Baseline characteristics, and perioperative and surgical outcomes were collected. Results: Overall, 10 robot-assisted pyeloplasties were performed (October 2022-September 2023). Based on our expertise, the following minor setting changes have been made, relative to the official setup guide: the endoscope port and, subsequently, the left and right-hand ports were positioned more laterally. Additionally, the reserve/4th port was placed more laterally and cranially, and adjusted the arm cart's tilt angle, reducing it from -30(degrees) to -15(degrees). The median docking time was 8 (interquartile range [IQR]: 7.2-9.8) minutes, and the median active console time was 89.5 (80.0-95.8) minutes. No conversion to open/laparoscopic surgery or perioperative complications was encountered. A single technical problem was recorded in 1 (10%) procedure. Specifically, one arm was blocked, and the procedure was accomplished with three arms without compromising the procedure success. Conclusions: This study represents the first worldwide series of robot-assisted pyeloplasty performed with the HUGO RAS system and shows promising results. The procedure might be safely performed with this robotic platform achieving optimal perioperative outcomes.

INTRODUCTION:Donor nephrectomy (DN) is a unique surgical procedure in urological practice, as it involves exposing a healthy individual to the potential risks of surgery. This type of surgery exhibits heterogeneity in terms of approach (open, laparoscopic, or robotic), each with its unique set of advantages and disadvantages. Consequently, there is currently a lack of universally agreed upon clear guidelines. In these settings, this study aims to evaluate transplantation surgeons' knowledge through a real-life survey and compare it with data from published randomized controlled trials (RCTs). EVIDENCE ACQUISITION:The study is divided into two parts, with the first part focusing on the outcomes of the real-life survey designed to assess surgeons' knowledge about different DN approaches and their real-world practices during the surgery. The second part involves a systematic review and meta-analysis of RCTs, specifically examining the outcomes of different surgical approaches to DN. The systematic review followed the PRISMA Guidelines and involved a search of PubMed and Web of Science for RCTs comparing the outcomes of different DN approaches. The risk of bias was assessed using the RoB-2 tool. The random effect model was mainly used to assess the mean difference of the included studies. EVIDENCE SYNTHESIS:The study was conducted between July 2021 and January 2022 and surveyed 50 surgeons, of which 35 participants (70%) completed the survey. Regarding various approaches to DN, 97.14% of surgeons reported having experience with live DN, and 45.72% performed over 15 cases per year. The most performed approach was pure laparoscopic DN (68.57%). Pure laparoscopic DN was the preferred approach for 77.42% of respondents. The review process resulted in 335 articles, of which 35 were eligible for inclusion in the systematic review. In summary, most studies found that laparoscopic approaches, including standard, hand-assisted, LESS-DN, and mini-LDN, resulted in less postoperative pain, better cosmetic, and quicker recovery times compared to open approaches. The main limitation of the current study is the heterogeneity of the included studies. CONCLUSIONS:The study provides valuable insights into the practices of renal transplantation surgeons, offering a comprehensive comparison to level 1 studies (RCTs) in the field. It underscores the continued significance of ODN in contemporary practice, particularly in light of recommendations from the EAU guidelines on renal transplantation. This reaffirms the need to consider the advantages and disadvantages of various approaches, including factors such as cost, postoperative pain, and cosmetic outcomes. While robotic-assisted DN holds promise, their adoption remains variable, potentially due to limited robust evidence.

BACKGROUND: Stone nomogram by Micali et al. , able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS: External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS: Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.590.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS: According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value. ( Cite this article as: Sighinolfi MC, Calcagnile T, Ticonosco M, Kaleci S, Di Bari S, Assumma S, et al. External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones. Minerva Urol Nephrol 2024 May 10. DOI: 10.23736/S2724-6051.24.05672-6)

Video S1. Step-by-step surgical procedure (accompanying video). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

BACKGROUND:In the field of robotic surgery, there is a lack of comparative evidence on surgical and functional outcomes of different robotic platforms. OBJECTIVE:To assess the outcomes of patients receiving robot-assisted radical prostatectomy (RARP) at a high-volume robotic center with daVinci and HUGO robot-assisted surgery (RAS) surgical systems. DESIGN, SETTING, AND PARTICIPANTS:We analyzed the data of 542 patients undergoing RARP ± extended pelvic lymph node dissection at OLV hospital (Aalst, Belgium) between 2021 and 2023. All procedures were performed by six surgeons using daVinci or HUGO RAS robots; the use of one platform rather than the other did not follow any specific preference and/or indication. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Multivariable analyses investigated the association between robotic system (daVinci vs HUGO RAS) and surgical outcomes after adjustment for patient- and tumor-related factors. Urinary continence recovery was defined as the use of no/one safety pad. RESULTS AND LIMITATIONS:A total of 378 (70%) and 164 (30%) patients underwent RARP with daVinci and HUGO RAS surgical systems, respectively. Despite a higher rate of palpable disease in the HUGO RAS group (34% vs 25%), baseline characteristics did not differ between the groups (all p > 0.05). After adjusting for confounders, we did not find evidence of a difference between the groups with respect to operative time (estimate: 16.71; 95% confidence interval [CI]: -6.35, 39.78; p = 0.12), estimated blood loss (estimate: 3.12; 95% CI: -67.03, 73.27; p = 0.9), and postoperative Clavien-Dindo ≥2 complications (odds ratio [OR]: 1.66; 95% CI: 0.34, 8.15; p = 0.5). On final pathology, 55 (15%) and 20 (12%) men in, respectively, the daVinci and the HUGO RAS group had positive surgical margins (PSMs; p = 0.5). On multivariable analyses, we did not find evidence of an association between a robotic system and PSMs (OR: 1.08; 95% CI: 0.56, 2.07; p = 0.8). Similarly, the odds of recovering continence did not differ between daVinci and HUGO RAS cases after both 1 mo (OR: 0.78; 95% CI: 0.45, 1.38; p = 0.4) and 3 mo (OR: 1.17; 95% CI: 0.49, 2.79; p = 0.7). CONCLUSIONS:Among patients receiving RARP with daVinci or HUGO RAS surgical platforms, we did not find differences in surgical and functional outcomes between the robots. This may be a result of a standardized surgical technique that allowed surgeons to transfer their skills between robotic systems. Awaiting future investigations with longer follow-up, these results have important implications for patients, surgeons, and health care policymakers. PATIENT SUMMARY:We compared surgical and functional outcomes of patients receiving robot-assisted radical prostatectomy with daVinci versus HUGO robot-assisted surgery (RAS) robots. The two platforms were able to achieve similar outcomes, suggesting that the introduction of HUGO RAS is safe and allows for optimal outcomes after radical prostatectomy.

Introduction and Hypothesis: Robotic sacropexy (RSC) emerged in the last years as a valid alternative to the laparoscopic technique. However, the robotic approach is still limited by platform availability and concerns about cost-effectiveness. Recently, new robotic platforms joined the market, lowering the costs and offering the possibility to expand the robotic approach. The aim of our study was to demonstrate the technical feasibility and safety of the procedure with this new platform along with the description of our surgical setting. Materials and Methods: We reported data on the first five consecutive patients who underwent RSC at Onze Lieve Vrouw Hospital (Aalst, Belgium), performed with the novel HUGO™ Robot-Assisted Surgery (RAS) System. The platform consists of four fully independent carts, an open console, and a system tower equipped for both laparoscopic and robotic surgery. We collected patients' characteristics, intraoperative data, intraoperative complications, and clashes of instruments. Results: All procedures were completed according to the same surgical setting and technique. No need for conversion to open/laparoscopic surgery and/or for additional port placement was required. No intraoperative complications, instrument clashes, or system failure that compromised the surgery's completion were recorded. Median interquartile range docking, operative, and console time were 8 (6-9), 130 (115-165), and 80 (80-115) minutes, respectively. Conclusion: This series represents the first worldwide report of a robot-assisted sacropexy executed with the novel HUGO RAS System. Awaiting future investigation, this preliminary experience provides relevant data in terms of operative room settings and perioperative outcomes that might be helpful for future adopters of this platform.

You have accessJournal of UrologyCME1 Apr 2023MP26-01 BENIGN PELVIC SURGERY WITH HUGO® RAS SYSTEM: OUR EXPERIENCE IN A TERTIARY REFERRAL ROBOTIC CENTER Eleonora Balestrazzi, Angelo Mottaran, Carlo Andrea Bravi, Luigi Nocera, Marco Paciotti, Adele Piro, Maria Peraire Lores, Luca Sarchi, Federico Piramide, Ruben De Groote, Geert De Naeyer, and Alexandre Mottrie Eleonora BalestrazziEleonora Balestrazzi , Angelo MottaranAngelo Mottaran , Carlo Andrea BraviCarlo Andrea Bravi , Luigi NoceraLuigi Nocera , Marco PaciottiMarco Paciotti , Adele PiroAdele Piro , Maria Peraire LoresMaria Peraire Lores , Luca SarchiLuca Sarchi , Federico PiramideFederico Piramide , Ruben De GrooteRuben De Groote , Geert De NaeyerGeert De Naeyer , and Alexandre MottrieAlexandre Mottrie View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic surgery for benign pelvic conditions – such as female urinary stress incontinence secondary to a pelvic organ prolapse and male benign prostatic iperplasia – can be performed using robotic and laparoscopic approaches. However, the robotic approach is still limited by platforms availability and their cost. Recently, new robotic platforms such as Hugo® Robotic Assisted Surgery (RAS) System were introduced into the market. The aim of our study was to assess the safety and technical feasibility of surgery for benign urological conditions with Hugo® RAS System. METHODS: We analysed data of 23 patients who underwent surgery for urological pelvic benign conditions at OLV Hospital (Aalst, Belgium). All surgeries were performed with HUGO™ RAS System between February and October 2022. We collected data about patient’s characteristics, operative time, intra- and post-operative complications, postoperative outcomes, clashing of instruments or technical errors of the system. RESULTS: Overall, 9 men underwent robot-assisted simple prostatectomy (RASP), 12 women robot-assisted sacropexy (RSC), 1 woman underwent robot-assisted diverticulectomy and 1 underwent robot-assisted Burch colposuspension. All procedures were completed, with no need for conversion or for placement of additional ports. No intraoperative complications and no one of the patients needed blood transfusion. One robotic monopolar curved shears had to be replaced during RASP, however no further instrument clashing or technical errors of the system occurred. Median (interquartile range [IQR]) console time for RASP was 120 (IQR: 100, 145) minutes and for RSC was 100 (IQR: 80, 100). The console time for the diverticulectomy and for the Burch colposuspension was 95 minutes and 100 minutes, respectively. Median length of stay was 4 (IQR: 3,5, 4,5) and 3 (IQR: 2, 4) days for RASP and RSC, respectively; length of stay for diverticulectomy and Burch colposuspension was 2 and 4 days, respectively. For all surgeries, vescical catheter was removed on the first operative day. Only one patient of the RASP group experienced a post-operative complication – an asymptomatic pelvic hematoma – that was conservatively treated. CONCLUSIONS: The use of HUGO® RAS system for the treatment of benign urological conditions, both in male and female patients, is safe and feasible. Awaiting further evidence on clinical outcomes, the introduction of this novel platform into the market can decrease the costs of robotic technology and thus increasing the availability of robotic surgery also for benign conditions in urology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e352 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eleonora Balestrazzi More articles by this author Angelo Mottaran More articles by this author Carlo Andrea Bravi More articles by this author Luigi Nocera More articles by this author Marco Paciotti More articles by this author Adele Piro More articles by this author Maria Peraire Lores More articles by this author Luca Sarchi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...