Editorial: The evolution of minimally invasive urologic surgery: innovations, challenges, and opportunities

Abstract

Large language models (LLMs) represent a rapidly expanding field, with many tested applications in the urological setting already. Talyshinskii et al provide an insightful summary of one of the most widely used LLMs, ChatGPT. The authors emphasize its role in drafting clinical documents and notes, in facilitating communication with patients, while medical students and clinicians can benefit from an educational and research perspective (1). Of course, attention is needed to avoid use of misleading or even fake references, plagiarism, scientific fraud, issues with patients' data privacy and isolation between patient and physician (1).Social media (SoMe) is a means of expression, while it also represents a way to communicate concerns, experiences and perceptions, especially regarding several health issues. Juliebo-Jones et al evaluated one of the most popular SoMe platforms, TikTok, regarding kidney stone surgery. The authors included the 100 most recent video posts and found that that the majority of posts were about recovery, pain and stents, while 51% showed a negative tone (2).Prostate cancer is one of the most common cancers in men, therefore it is reasonable that a lot of research focuses on this field. Haack et al designed a comparative study to assess the ability of urologists to localize suspicious cancer lesions on multi-parametric (mp) magnetic resonance imaging (MRI), when having only mpMRI images, mpMRI images with radiological reports and mpMRI images with 3D printed model; they reported that radiology reports are still needed, while 3D models seem to be efficient, especially in younger residents (3). Radical prostatectomy still represents a main form of management of localized disease and while it offers high survival rates, two of its associated sequelae, incontinence and erectile dysfunction, hinder its popularity. Leitsmann et al assessed the impact of mpMRI-targeted biopsy on functional outcomes in patients undergoing robot-assisted radical prostatectomy (4). They reported that mpMRI-targeted biopsy compared to standard biopsy, led to fewer positive surgical margins, lower risk of erectile dysfunction at 1-year, lower rate of postoperative tumor upgrading and, in cases of nerve-sparing approach, fewer secondary nerve resection (4). Katsimperis et al provided a concise summary with their narrative review on the approaches used to preserve continence after robot-assisted radical prostatectomy; bladder neck preservation, neurovascular bundle preservation, preservation of apical intraprostatic urethra, Retzius-sparing and hood techniques, anterior and/or posterior reconstructive stiches and newer techniques such as complete urethral preservation (CUP) and single port transvesical robotic prostatectomy (5). A critical step of radical prostatectomy, where a large amount of blood loss can occur, is deep vascular complex ligation. Chen et al described a simulation platform for training of novice surgeons and residents on this step, showing good construct, face and content validity, while maintaining low costs (6).Partial nephrectomy is the treatment of choice in cases of T1 renal tumors and in selected cases in larger neoplasms, in order to maximize renal function preservation. Conventional technique, either performed via an open or minimally invasive approach, consists of the renal arterial supply (warm ischemia) and subsequently excising the tumor and suturing the tissue defect, usually in two layers (inner and outer renorrhaphy). Several techniques have been described, with the sliding technique using clips to support the tissues and barbed sutures being the most commonly used one. Nguyen et al performed an in-vivo study to evaluate the use of off-clamp, microwave scissors-based and sutureless partial nephrectomy technique, compared to on-clamp conventional approach; they reported that the former one exhibited reduced surgical time and less normal nephron loss, while blood loss and urinoma formation were not sig