NARUS 2024: A Glimpse Into the Future of Robotic Urology

The Eighth Annual North American Robotic Urology Symposium (NARUS), which took place in Las Vegas, Nevada, February 22-24, 2024, served as a valuable platform for surgeons and researchers to share their expertise and insights into the latest advancements and future directions of robotic urological surgery. This article focuses on key takeaways from several presentations and highlights areas of ongoing development and potential improvements in patient care.

Managing Ureteral Strictures

Dr. Alvin Goh, of Memorial Sloan Kettering Cancer Center (MSKCC), presented data suggesting a potential higher rate of benign ureteral strictures following robotic radical cystectomy compared with the open approach. However, he attributed this difference to the fact that most analyzed data come from the early years of adopting robotic cystectomy (2009-2014). Dr. Goh emphasized the importance of preserving blood supply, minimizing unnecessary dissection around the ureter, and employing careful surgical technique to prevent strictures. Additionally, he presented encouraging preliminary results from MSKCC on omitting ureteral stents during ileal conduit formation, potentially leading to fewer urinary tract infections and reduced hospital readmissions.

Bladder Diverticulectomy: A Choice of Technique

Dr. Daniel Eun, of Temple Health, shared his experience with managing bladder diverticulectomy, which can be performed in conjunction with robotic simple prostatectomy for benign prostatic hyperplasia or radical prostatectomy for prostate cancer. He presented a guideline for selecting the surgical approach (intravesical vs extravesical) based on the size, location, and presence of tumors within the diverticulum. This method ensures that the most appropriate technique is employed based on the specific characteristics of each case. He emphasized the importance of meticulous dissection to avoid injuring the ureter and showcased his techniques with video examples, offering valuable insights into his surgical expertise.

Mastering Bowel Handling in Robotic Surgery

Dr. Mihir Desai, of the Keck School of Medicine of USC, offered practical tips and tricks for bowel handling during robotic surgery. He discussed port placement strategies, including the use of a 15-mm port at the left lateral segment, to provide optimal access for bowel stapling and minimize manipulation. He also emphasized core principles for careful bowel dissection, such as using appropriate instrumentation and verifying bowel vascularity to avoid accidental injury. These essential insights aim to further improve surgical safety and minimize the risk of complications associated with bowel handling during robotic procedures.

Single-Port Robotic Surgery: Expanding Possibilities

Dr. Ketan Badani, of the Icahn School of Medicine at Mount Sinai, presented an update on single-port (SP) robotic surgery and its potential applications in 2024. He reviewed various SP techniques, including SP partial nephrectomy, which involves removing a portion of the kidney. He also presented a decision-making algorithm that considers factors like tumor location and size to help surgeons select appropriate cases for this minimally invasive approach. Dr. Badani’s presentation, which was accompanied by numerous video demonstrations, highlighted the potential of SP robotic surgery to expand the scope of minimally invasive procedures, potentially leading to faster recovery times and improved patient outcomes.

Optimizing Renal Reconstruction After Partial Nephrectomy

Dr. Ronney Abaza, of the Central Ohio Urology Group, delivered a valuable lecture on renal reconstruction (renorrhaphy) following partial nephrectomy, a procedure performed to remove cancerous tissue from the kidney while preserving as much healthy tissue as possible. Dr. Abaza emphasized the importance of meticulous hemostasis to prevent complications such as urine leaks, fistulas, and pseudoaneurysms. He stressed the significance of early unclamping to identify bleeding vessels and avoid excessive reliance on hemostatic agents, promoting efficient blood flow control during the procedure. Additionally, Dr. Abaza shared specific technical tips for his approach to renal reconstruction, enriching the audience’s understanding of this crucial aspect of kidney preservation surgery.

NARUS 2024 was a window into the exciting advancements and ongoing efforts in the field of robotic urology. The conference highlighted several areas where robotic surgery is making significant strides, offering the potential for improved surgical outcomes, reduced patient morbidity, and faster recovery times. From managing complications following procedures to refining minimally invasive approaches, the presentations emphasized the continuous advancements that promise a future of enhanced patient care in the field of urology.

Akhil Abraham Saji, MD, Fellow at the University of Southern California, is a urologist specializing in minimally invasive surgery and urologic oncology with an interest in technology-driven innovation within health care.