Will robots help reduce the HoLEP learning curve?
Holmium laser enucleation of the prostate (HoLEP) is increasingly gaining acceptance as a superior option for permanent benign prostatic hyperplasia (BPH) symptom relief that can treat patients with any size prostate. The procedure involves complete removal of all adenomatous tissue, preventing regrowth and reducing the need for reintervention.
In the hands of an expert operator, HoLEP consistently results in durable symptom relief with a side-effect profile that compares favourably to all other surgical treatment options for BPH.
HoLEP’s steep learning curve has long posed an obstacle to adopting the procedure. Gaining proficiency in the procedure can require over 50 cases, and it is impractical for many urologists to undergo such an extensive training programme. The key challenges typically involve recognising the surgical plane and orienting oneself relative to anatomical landmarks.
Robotics and artificial intelligence (AI) may afford new opportunities to shorten the learning curve for HoLEP and make the procedure accessible to more urologists. Models based on computer vision have the potential to recognise key landmarks, provide navigational guidance, and recognise and prevent procedural errors before clinical consequences occur. Such decision support tools may lower the barriers to performing HoLEP confidently and consistently.
Andromeda Surgical (San Francisco, CA, USA) is developing a robotic platform with AI guidance designed to reduce the learning curve for HoLEP and empower any urologist to perform the procedure efficiently with consistent expert-level results.
The urologist uses a handheld controller to control a robotic arm that manipulates the scope and laser fibre. Algorithms trained on a large volume of case data inform visual overlays that assist the surgeon in navigating, following anatomical planes, and progressing efficiently through the enucleation process. Data collected through future clinical use will enable further enhancements, allowing parts of the procedure to be performed autonomously. Making the procedure robotic may also provide ergonomic benefits by reducing the physically taxing.
The product is currently in the preclinical stage, with first clinical use anticipated within the next year. Will robots help urologists adopt anatomic endoscopic enucleation of the prostate soon? We have to wait and see, but robots have already enhanced our ability to perform surgical procedures in many areas, and likely, they will.
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This article first appeared in the January-February 2024 edition of European Urology Today.