Urology Beyond Europe: Great potential for telesurgery in island-rich ASEAN region
The introduction of lower-cost robotic systems from India and China are going to be a game changer in Southeast Asia (the ASEAN Countries) in the coming years. This was the major conclusion from the first part of the Joint Session of the EAU and the Federation of ASEAN Urological Associations (FAUA), chaired by Prof. Bernard Malavaud (Toulouse, FR) on behalf of the EAU and Prof. Paksi Satyagraha (Malang, ID) on behalf of FAUA.
The “game changer” comment came from Dr. Samuel Vincent Yrastorza (Quezon City, PH), who co-moderated the first part of the session, which covered the adoption of robotic urology in the region. Experts believe that the cheaper robots, combined with investment from governments, regional training and innovations in telesurgery, will speed up adoption rapidly and improve patient care in remote regions.
Dr. Yrastorza’s co-moderator, Prof. Antonio Alcaraz (Barcelona, ES) also pointed out that telesurgery has potential beyond the convenience of European doctors operating on wealthy patients at a distance, but could actually help overcome the very real geographical challenges health systems in countries like Indonesia face.
The Urology Beyond Europe sessions are held on the first day of the EAU’s Annual Congress to emphasise the international ties between the EAU and the world’s urological societies also showcasing the great diversity in challenges urologists face around the world. The 40th Annual EAU Congress is taking place in Madrid, Spain on 21-24 March 2025.
Challenges in the Indonesian archipelago
The morning’s session started with a presentation by Prof. Agus Rizal Hamid from Jakarta, Indonesia, outlining the unique challenges his country faces with adopting robotic systems. Indonesia would in potential greatly benefit from telesurgery, as it is made up of 17,500 islands, making travel between them by either surgeons or patients a costly and time-consuming operation.
The challenge also applies to training. With major surgical centres in Java and so far, the only robotic systems in the nation’s capital of Jakarta, doctors in the outer regions have to travel to gain experience. Telesurgery would remove that barrier, with experienced surgeons in the capital telementoring and assisting young urologists on other islands.
Prof. Hamid explained that technological barriers like latency in telecommunications are nearly overcome, and the first successful trials (at distances of 500 and 1200km) took place in the autumn of 2024. The Indonesian Ministry of Health is actively encouraging the adoption of robotic systems and telesurgical practice, working together with Iran.
The session continued with Prof. Thai from Ho Chi Minh City in southern Vietnam, who outlined how robotic surgical systems were adopted in his country in the past decade. Training occurs partially in other countries like South Korea, but both Ho Chi Minh City and Hanoi (the two major population centres) currently have robotic centres, a total of five.
The morning’s session ended with a lecture from Dr. Noor Ashani from Kuala Lumpur (MY), who gave an excellent overview of the ASEAN region as a whole. The region’s nations have a common vision, as expressed in the ASEAN Association, but contrary to blocs like the European Union, there is more autonomy between the participating countries.
The region has 600 million citizens, compared to the European Union’s 450, with Buddhism, Islam and Christianity as major religions and cultures. The GDP per capita also varies wildly, from the very high in Singapore and Brunei to the lower in Indonesia. Dr. Ashani pointed out that within Indonesia, the richest 10% alone had a larger GDP than neighbouring Malaysia, so there is tremendous variety even within countries.
Turning to the adopting of robotic surgery, and the necessity of telesurgery in the region, Dr. Ashani pointed to the differences in geography. Small countries like Singapore had no national necessity for telesurgery but could help its neighbours, while Brunei, while extremely rich, did not have the manpower to have a robotic centre of its own. The aforementioned unique geography of Indonesia was ideally suited to the expansion of telesurgery to help patients and doctors in peripheral regions.
The session continued to cover reconstructive surgery (a result of the relatively high number of traffic accidents in the ASEAN region), as well as lifestyle and urological cancers (for instance herbal supplements). Urology Beyond Europe sessions continued throughout the day. More reporting to come.