Plenary Session 1-2

Jeff S. ChuehTaiwan Moderator

Ryoichi Shiroki Japan Speaker Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback. Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms. hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside. DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness. Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology. Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically. In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.

Michael WongSingapore Moderator Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives Dr Michael YC Wong Principal Director of ASU 2022-2026 President Endourological Society and WCET 2026 Introduction Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ). One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons. In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress. The Growth Trajectory for the next 4 years 2022-2026 There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history. There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community. 1. Lasting and strong Relationships 1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years. 1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship. 1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026 2. Education Platform for Asian Urology Residents From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com 3. Re-Strategize Training cum fellowship sites for ASU. 3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues. 3.2 What can we do that is possible? Let us consider two options in the next 4 years. 3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China. ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK. 3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative 4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years. It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!

Ketan BadaniUnited States Speaker Expanding horizons: SP for complex RAPNThe Future of Urological Robotic SurgerySingle-Port Robotic Partial Nephrectomy for Multiple or Large Renal TumorsHow to Standardize Training by AI-Learning from The Best Practice of Urological Robotic SurgerySP Partial Nephrectomy

Rajeev KumarIndia Moderator Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRSProstate Cancer Nomograms and Their Application in Asian MenNomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate cancer, nomograms were developed for determining need for biopsy, disease course, need for adjuvant therapy, and outcomes. Most of these predictive nomograms were based on Caucasian populations. Prostate cancer is significantly affected by race, and Asian men have a significantly different racial and genetic susceptibility compared to Caucasians, raising the concern about the generalizability of these nomograms. There are very few studies that have evaluated the applicability and validity of the existing nomograms in in Asian men. Most have found significant differences in the performance in this population. Thus, relying on such nomograms for treating Asian men may not be appropriate and collaborative efforts are required within Asian countries to develop locally relevant nomograms.What Is Critical Appraisal?Critical appraisal is the process of systematically evaluating research studies to assess their validity, relevance, and trustworthiness. The goal is to determine whether a study’s results are credible and useful for clinical decision-making, research, or policy. This has become increasingly important as there has been a massive increase in the number of scientific journals and not all published research is of equal quality. Critical appraisal helps healthcare professionals avoid being misled by poor-quality studies, make evidence-based decisions and improve patient outcomes. The key purposes are to assess validity of the study and its results and determine applicability to the specific population. It involves assessing the study design, methodological quality, completeness of reporting, potential sources of bias and potential for misconduct. There are number of reporting guidelines that can be used for performing critical appraisal. Additionally, being aware of essential reporting standards and common problems with studies can help readers make informed decisions.Scientific Misconduct and PitfallsNo abstractExample of the “Ideal” AbstractNo Abstract

Simone CrivellaroUnited States Speaker Single-Port vs. Multi-Port Robotic Prostatectomy: Balancing Innovation, Precision, and OutcomesThe Application & Limitation of Urological SP SurgerySingle Port Retroperitoneal Partial NephrectomySingle Port Prostate Surgery

Khalil ArmachLebanon Moderator

Masatoshi EtoJapan Speaker Current Status & Future Perspective of Surgical Navigation in Robotic SurgeryRobot-assisted partial nephrectomy (RAPN) is a standard treatment for small renal cancer, however, the number of reports on the development of the image supported system and its effectiveness is small. The key point in the procedure of RAPN is to reliably identify renal artery in a space with few landmarks and to resect a tumor. To performe RAPN safely and reliably, we have already developed a surgical navigation specialized for RAPN, and published its usefulness in daVinci surgical systems. In this lecture, I would like to talk our recent projects updating our current navigation system. The first project focuses on 3D navigation using real-time forceps tracking. The second project is to develop an AI-based autonomous registration method for surgical navigation in RAPN. I hope that these 2 projects will further enhance the usefulness of our navigation system in RAPN.

Rainy UmbasIndonesia Moderator

Chi-Fai NgHong Kong, China Speaker Novel Robotic Surgery PlatformsOver the past decades, robotic surgery has become an essential approach in urological care. The recent blooming of different robotic platforms, in particular in Asian countries, has helped popularize robotic surgery in less developed countries. The introduction of robotic technology in endoluminal surgery has also helped to open up opportunities to further improve endourology. In the future, the incorporation of AI in robotic systems will help upgrade the standard of care in urology.

Hong Gee SimSingapore Moderator

Mario Gyung-Tak SungKorea (Republic of) Speaker What's Next in Urologic Robotics in Asia: Future PerspectivesAdvancement of Novel Instruments/Gadgets in Urological Robotic Surgery