The Association of Urologists of Slovenia, the Clinical Department of Urology and the Clinical Department of Abdominal Surgery at the University Medical Centre Ljubljana, annually present the latest developments, achievements, and advances in robotic surgery in Slovenia.
Medip organized a satellite symposium featuring Prof. Jihad Kaouk, who presented the achievements of the Cleveland Clinic team with more than 2,000 robotic transvesical prostatectomies performed through a single surgical incision. This approach represents a significant milestone in the evolution of robotic surgery.
Prof. Kaouk emphasized the importance of a completely closed CO₂ insufflation system. According to reports from the United States (FDA MAUDE database), numerous complications have been associated with the inadvertent introduction of ambient operating room air into the surgical field. Such events may contribute to subcutaneous emphysema, prolonged patient recovery due to the slower absorption of air compared with medical-grade CO₂, air embolism, and, in rare cases, serious adverse outcomes.
He also highlighted the benefits of heated and actively humidified CO₂ insufflation. In addition to supporting faster patient recovery, heated and humidified CO₂ minimizes lens fogging, improves intraoperative visualization, and enables smoother surgical workflow, even during extensive suctioning.
When discussing single-port transvesical prostatectomy, Prof. Kaouk described a technique involving a reduction of pneumoperitoneum pressure from 10 mmHg to as low as 1 mmHg. Such low pressure facilitates the creation of vesicourethral anastomosis while minimizing tissue tension and mechanical stress. The LEXION insufflator, in combination with Insuflow double-wall trocars, can maintain these ultra-low-pressure conditions. Lower pressures have also been associated with a reduced incidence of venous air embolism.
The symposium additionally explored how the latest generation of intelligent insufflation systems may facilitate selected robotic procedures under epidural anesthesia, potentially opening new opportunities for enhanced patient care and faster postoperative recovery.
