In the latest edition of European Urology, Thillou et al. present a groundbreaking case series comprising 10 instances of robotassisted radical prostatectomy (RARP) procedures conducted using the innovative Dexter robotic system by Distalmotion SA, Épalinges, Switzerland. This marks the maiden exploration of RARP employing the Dexter system, which encompasses an open surgeon console, two patient carts, and a robotic endoscope arm, resembling a conventional laparoscopic setting. Remarkably, all procedures were executed without complications, conversion to open surgery, or significant technical mishaps, thereby underscoring the safety and viability of RARP with the Dexter system. Since its inception in 1995, Intuitive Surgical’s da Vinci surgical system has dominated the robotic surgical market. Nevertheless, recent years have witnessed the introduction of several new robotic platforms boasting unique features. Notably, the Dexter robotic system stands out with its concept of a sterile surgeon console environment, enabling on-demand surgery and facilitating swift transitions to a traditional laparoscopic setup. Although the utility of switching between different approaches may be debatable, this feature notably eases the transition to a robotic approach, particularly for centres proficient in laparoscopy, as evidenced by the surgeons in this case series. However, irrespective of the surgeon’s proficiency, the learning curve for robotic surgery is a crucial consideration. Thillou et al. report a lengthy median operative time, approaching four hours, attributed to the learning curve inherent in their initial robotic experience, challenging the notion that laparoscopic surgeons hold an advantage in transitioning to a robotic approach. This learning curve underscores the enhancement in surgical outcomes with increasing experience, encompassing technical aspects, complications, and oncological or functional results. To optimise the learning curve for robotic procedures, standardised and validated training curricula are imperative. Several robotic training programmes, including those developed by the European Association of Urology Robotic Urologic Section, aim to standardise major robotic urological procedures and enhance reproducibility. Moreover, modulated training based on proficiency-based progression simulation training has shown promising outcomes in terms of technical skills. However, it is crucial to note that such results are primarily derived from surgeons utilising the da Vinci 5 robotic system, necessitating tailored training for each new robotic platform, including the Dexter system. In conclusion, the burgeoning accessibility of robotic surgery, coupled with the emergence of new systems, promises enhanced precision and minimally invasive procedures across diverse healthcare settings. Embracing these advancements and fostering technical skills through tailored training programmes are imperative for the successful adoption of new robotic approaches and technologies in surgical practice.
How to handle the opening market in robotic surgery
Reviewed by Asif H Ansari
Opening up the market to new robotic platforms: the best way to handle new options.
