Ruben Olivares

Introduction: Single-Port Transvesical Enucleation of the Prostate (STEP) is a minimally invasive robotic technique for managing benign prostatic hyperplasia (BPH), particularly in prostates ≧ 80 cc. However, its outcomes in very large prostates (>150 cc) remain under-characterized. We compared perioperative and functional outcomes of STEP between large (LP: 80–150 cc) and very large prostates (VLP: >150 cc). Materials and methods: We retrospectively reviewed 183 patients who underwent STEP using the da Vinci Single-Port system (2019–2024). Patients were stratified into LP and VLP cohorts based on prostate volume (PV). Enucleation efficiency was defined as enucleated tissue weight divided by enucleation time (g/min). Outcomes were compared using descriptive statistics. Results: A total of 179 patients were included (LP: 93; VLP: 86). Median PV was significantly greater in the VLP group (194 vs. 117 cc, p < 0.001). VLP patients had higher PSA (9.7 vs. 6.75 ng/mL, p = 0.002), longer enucleation (84 vs. 69 min, p = 0.002) and console times (115 vs. 98 min, p = 0.010), and improved enucleation efficiency (1.23 vs. 0.97 g/min, p = 0.025). Estimated blood loss was slightly higher in VLP (100 vs. 80 mL, p = 0.026). All procedures were completed without conversion or additional ports. Hospital stay, catheter duration, and same-day discharge rates were comparable. At 3 months, both groups had equivalent improvements in International Prostate Symptom Score (3 vs. 3, p = 0.913), quality-of-life scores (0 vs. 1, p = 0.965), and maximum flow rate (17.5 vs. 16 mL/s, p = 0.594). Complications were rare, with no readmissions and only two major postoperative events. Urinary continence was preserved in all patients, with transient incontinence occurring in 6 patients (LP: 2; VLP: 4), resolving completely by 3 months. Conclusions: STEP is effective and scalable for prostates ≥ 80 cc, demonstrating improved enucleation efficiency in very large glands without compromising safety, recovery, or continence preservation.

Introduction: Telesurgery represents an emerging frontier in the surgical management of prostate cancer, offering innovative solutions to expand access to specialized care across geographic and institutional barriers. This systematic review aims to evaluate the feasibility, clinical outcomes, and technical considerations of telesurgical applications in the treatment of prostate cancer. Methods: A comprehensive literature search was conducted across MEDLINE (via PubMed), Embase, Scopus, and Web of Science in June 2025 to identify all consecutive clinical studies published from 2001 through June 2025 that involved telesurgical approaches for the management of clinically significant, localized prostate cancer. Eligible studies were screened and reviewed according to PRISMA guidelines, and a narrative synthesis was performed. Results: A total of six studies met the inclusion criteria, demonstrating successful telesurgical procedures involving 7 patients, with six procedures pertaining to Robot-Assisted Radical Prostatectomy (RARP) and one case of High-Intensity Focused Ultrasound (HIFU) focal therapy. All procedures were completed successfully over distances ranging between 1 and 11,412 km. The most commonly utilized network infrastructure included 5 G wireless and wired fiber-optic broadband systems. With a round-trip latency ranging between 6 ms and 464 ms, no technical failures and no clinically meaningful delays perceived by the surgeons were reported. Conclusions: Herein, we demonstrated the feasibility and safety of radical and focal robotic telesurgical procedures for the management of prostate cancer. Despite its successes and benefits in democratizing patient care and surgical education, challenges surrounding its cost, regulatory frameworks, and standardization of care may continue to pose limitations, underscoring the need for further research and policy innovation.

Background: Grade Group 1 (GG1) prostate cancer is biologically indolent and typically managed with active surveillance (AS), yet pT3a pathology is occasionally identified at radical prostatectomy (RP). Its prognostic significance in GG1 disease remains incompletely defined. Methods: Retrospective cohort of 40 patients with GG1 and pT3a disease on RP (2000–2022), confirmed on central pathologic re-review. Results: Four patients developed biochemical recurrence (BCR); the cumulative incidence of BCR was 3.2% at 5 years and 10.3% at 15 years. No patient developed metastatic disease or prostate cancer–specific mortality. Conclusions: GG1 pT3a prostate cancer demonstrates excellent long-term outcomes. Adverse histologic features, not pathological stage alone, drive clinically meaningful risk. Late, stable PSA detectability alone does not signify meaningful recurrence.

The advent of telesurgery has opened a new frontier within minimally invasive surgery, allowing surgeons to complete procedures from a remote location and providing new opportunities for the delivery of care. Herein, we present the first clinical experience of telesurgery using high intensity-focused ultrasound (HIFU) for focal treatment of prostate cancer. The procedure was performed using the Focal One^® device (Focal One, Austin, TX, USA) on a 72-year-old with an ISUP Grade Group 2 prostate cancer from a single biopsy core that corresponds to a PIRADS 4 lesion in the left mid-apical region. A secure remote connection was established using the Software-Defined Wide Area Network (SD-WAN) infrastructure between the purpose-built virtual desktop for the console surgeon in Cleveland (OH, USA) and the operating room in Abu Dhabi (United Arab Emirates), spanning a total distance of 11,412 km (7091 miles). A total volume of 26.4 cm³ was ablated within 50 minutes of ablation time. Intraoperative blood loss was minimal, and there was no evidence of perioperative complications. With the total round-trip latency of 115 milliseconds, there remained no perceptible disruptions that were noted during the procedure. Notably, this collaborative effort marked a significant milestone that underscored the safety and feasibility of HIFU telesurgery for the management of localized, clinically significant prostate cancer. This remote surgery model using an already established network infrastructure, offers significant promise for expanding access to specialized, high-quality medical care, particularly in underserved regions.

Introduction and Objectives: Radiofrequency is standardized for ablating small renal tumors, but evidence regarding its effects remains limited. Partial nephrectomy, the gold standard, often leads to hemorrhagic complications and irreversible renal damage due to hilum clamping. To mitigate these risks, we propose a novel technique that replaces clamping with radiofrequency ablation of the tumor for hemostasis in robot-assisted partial nephrectomy. Methods: We report on 357 consecutive patients with T1a renal tumors treated with robot-assisted surgery between 2010 and July 2024. Radiofrequency was used peri-tumorally for hemostasis, followed by complete lesion enucleation. Follow-up included ultrasound and creatinine at 1 month, CT scans at months 3 and 9, and then annually for 5 years. Results: The median age was 60.2 years, with 251 men (70.3%). The median tumor size was 22 mm, and the median blood loss was 15 mL. Hemorrhagic complications occurred in eight patients (2.2%), with one requiring a blood transfusion (0.28%). A total of 30 patients experienced transient stage 1 acute kidney disease (8.4%), with no significant change in median 74.92 mL/min/1.77 m² vs. 78.77 mL/min/1.77 m² vs. (p-value 0.15). The median follow-up was 48.2 months, with no tumor recurrence at the treated site. Renal cell carcinoma was found in 83.7% of tumors. Conclusions: To our knowledge, this series represent the largest global undertaking of renal tumor treatment using peripheral radiofrequency ablation without clamping, demonstrating optimal surgical and oncological outcomes, lower morbidity, and fewer complications compared to those noted in the revised literature regarding traditional clamping techniques.

Purpose To provide an update on the diverse, contemporary urological applications of the Hugo™ RAS system. Methods A comprehensive literature review was performed to identify studies that described the clinical applications of the Hugo™ RAS system in Urology. The Hugo™ RAS is a new multi-modular robotic platform created by Medtronic, which offered new innovations, including an open surgical console and individual modular and extendable robotic arms that come in their own movable platforms. Since obtaining regulatory approval in Europe in October 2021, the novel platform has been increasingly used in various urologic and gynecologic procedures. Results A total of 10 studies were included, which involved 176 patients who underwent varying urological procedures. These included radical and simple prostatectomy, partial nephrectomy, radical and simple nephrectomy, ureterolithotomy, ureteral reimplant, pyeloplasty, and adrenalectomy. The different docking configurations, operating room set-ups, and early perioperative outcomes were described for the respective procedure. Conclusion Based on the existing literature, the Hugo™ RAS system can be safely and effectively utilized for various urological procedures. The novel technology provided additional value in enriching the repertoire of urological minimally invasive surgical options. Further research with larger cohort of patients will be required to better refine the operating techniques and understand the perioperative outcomes of the Hugo™ RAS, especially when compared to other robotic surgical platforms.