"Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes

Feasibility and Initial Outcomes of Telesurgery in Urology: a Systematic Review of the Literature

INTRODUCTION

Telesurgery allows the procedures to be carried out over long distances, however due to lack of data, its feasibility has not been consolidated yet. Since it is a promising modality, it is important to illustrate the current scenario on this subject.

OBJECTIVE

To review the literature aiming at the surgical success rate as a primary objective, and secondly, the most important patient outcomes and the network system.

MATERIALS AND METHODS

In June 2024, we followed PRISMA guidelines to research trials on urological robotic surgery in humans. We used as exclusion criteria: editorials, specialist's opinions, tele-mentoring, tele-training, small procedures, non-remote surgeries, absence of interest outcomes, telesurgeries in non-humans or in cadaver.

RESULTS

Five hundred and ninety eight studies were identified with peer review and a third reviewer for divergencies, both directed by previously established inclusion and exclusion criteria, selecting 6 studies after the exclusions. We found 54 patients who underwent urological telesurgeries; all of them were accomplished with no complications or need for conversion to open surgery. Almost all the procedures were carried out in China (98.14%) and the most used robotic model was MicroHand S (83.33%). Nephrectomy was the procedure of choice (57%). Mean surgical time was 66.2 (IQR) 56.6 minutes. Intraoperative bleeding time was 68.6 ± 76.7 milliliters. Hospital stay was 5.5 (IQR) 5 days. The distance between main surgeon and the patient was between 2,581.5 (IQR) 2,871 kilometers. 5G network was used the most (98.14%). The total network latency time was 176 (IQR) 10.9 milliseconds.

CONCLUSION

Despite its limitations, there was evidence demonstrating that robotic surgery in the genitourinary system is safe and feasible, however it is a subject that must be well discussed, and further studies must be carried out.

The Co-Surgeon Model for Microsurgical Free Flaps: A Survey of Perspectives and Utility

Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeon perspectives on the utility of the co-surgeon model.A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (± 9.7) years. Most of the microsurgeons were male (71%) practicing in the United States (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with immediate lymphatic reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4 and 36.4%, respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves "very much" or "quite a bit" operative efficiency and duration, as well as surgeon well-being and career longevity.This study provides new insight into the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon well-being, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting well-being among microsurgeons.