Daniel Eun, MD, on telesurgery, AI, and the future of reconstructive urology

In part 2 of his conversation with Urology Times®, Daniel D. Eun, MD, of Jefferson Health, explores how emerging technologies could reshape reconstructive urology in the years ahead. While robotic surgery is already deeply embedded in the specialty, Eun says the next phase of innovation may come from a convergence of telesurgery, artificial intelligence (AI), advanced imaging, and intraoperative guidance technologies.

Eun discusses why telesurgery has moved from a theoretical concept to a technical reality, citing advances in ultralow latency fiber-optic connectivity and satellite backup systems that now enable surgeons to operate across vast distances. However, he also explains why widespread adoption in the US remains unlikely in the near term, citing unresolved questions about regulation, legal liability, reimbursement, and clinical necessity. In contrast, he suggests that countries with limited access to surgery and fewer regulatory barriers may becomeearly proving grounds for remote surgery.

The interview also looks ahead to AI-assisted reconstruction, including image overlays, 3D localization, and injectable markers that could help identify tumors, nerves, and other critical structures in real time. Eun reflects on how innovations such as robotic buccal mucosa graft ureteroplasty transformed ureteral stricture management over the past decade, and why he believes the next true breakthrough in reconstructive surgery will be AI-driven.

You can view part 1 of this conversation here.

Urology Times: Telesurgery and remote proctoring are gaining traction. What are the technical, regulatory, and ethical challenges that still need to be addressed before telesurgery can be widely adopted in reconstructive urology?

Eun: Remote proctoring has been around for more than a decade now, but for several reasons, it has not really caught on in a very impactful way here in the US. I would say that here in the US, issues related to legal responsibility and reimbursement for time are some of the reasons why this is the case.

Telesurgery has more recently made a big splash with transoceanic telesurgery evolving from proof-of-concept to reality. Ultralow-latency fiber-optic data link with satellite backup has enabled numerous surgeons to demonstrate that long-distance surgery can be performed safely and efficiently. Here in the US, we have yet to work out regulatory issues related to telesurgery, but it would be hard to justify the necessity. In many developing countries, where limited access and geographical challenges exist for patients, telesurgery starts to make much more sense. The places where telesurgery will be pioneered first will be countries that have less regulatory burden. It will be interesting to see how this plays out as “westernized” health care systems tend to be more regulated and may fall behind.

Urology Times: Are there any other innovations—whether in instrumentation, imaging, or surgical technique—that you believe will meaningfully change reconstructive urology in the next few years?

Eun: For the past 10 years, I was one of the leading pioneers for using buccal mucosa grafts from the inner cheek lining to fix ureteral stricture disease. I recently published our 10-year outcomes data in a multi-institutional series showing a high success rate that was durable and safe.¹ It was a true breakthrough in raising the bar and advancing surgical outcomes for ureteral stricture disease patients all around the world. A true innovation like that comes once in a lifetime, and I’m so fortunate to have been at the forefront of this advancement.

I believe the next wave of advancement will be AI-driven when it comes to a true, game-changing surgical advancement. Image overlay, computer-aided in situ 3D localization of marked structures, and usage of various injectable agents to mark cancer, nerves, and other critical structures have an amazing potential to make surgery safer and more efficient.

Urology Times: Is there anything else that you’d like to add?

Eun: I trained as a robotic cancer surgeon in the mid-2000s, and I never imagined that nearly 50% of my practice would evolve toward robotic reconstructive surgery. Many of my patients travel a great distance to seek my care and are so appreciative that I am willing to take on their case. What I find truly rewarding is the ability to transform a patient’s life by solving a problem that others have given up on or deemed “impossible.” When you can take a patient who has been tormented with indwelling tubes, intractable pain, and relentless infections and suddenly restore their life back to normal, it stirs an immense sense of satisfaction in your profession and craft. At the same time, the complexity that comes with reoperative surgery is extremely stressful, and I often feel that I am a glutton for punishment. I have found that the combination of high risk and high reward keeps me constantly thankful, as I am always reminded of the great privilege it is to be a surgeon.

REFERENCE

1. Chao BW, Raver M, Lin JS, et al. Robotic buccal mucosa graft ureteroplasty: a decade of experience from a multi-institutional cohort. Urology. 2025:197:174-179. doi:10.1016/j.urology.2024.11.059