Editorial Comment for Mitchell et al.

“Towards Improving Transurethral Prostate Surgery: Development and Initial Experiments with a Novel Concentric Tube Robotic Platform” for the Journal of Endourology.

The referenced work represents a preliminary result of a novel approach to transurethral enucleation of the transition zone of the prostate. Although the authors have clearly expended considerable effort in the design and modeling of this platform, there are several overt and implied assumptions that may have a problem with face validity. The assumption that the limiting aspect of Holmium Laser Enucleative Prostate (HoLEP) is the “complex scope movements” overstates the clinical challenge. Anyway, this technology appears to make any such complex scope maneuvers even more complex with this robotic interface.

The authors need to address an issue with generalizability of the HoLEP procedure: fate of the enucleated free floating prostate and risk of bladder injury with its removal. The problem and risk are not the dissection of the transition lobe but rather its removal. Given recent publications on the major technologies for lower urinary tract symptoms secondary to benign prostatic hyperplasia many of the attributed advantages of HoLEP over other methods, the issue of gland morcellation problems are worth reviewing. The authors have clearly worked in earnest to develop a robotic technology for HoLEP and for this they are to be congratulated.