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Advances in Laparoscopic and Robotic Surgery in Urology
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Advances in Laparoscopic and Robotic Surgery in Urology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (20 September 2024) | Viewed by 8328

Special Issue Editors

Dr. Mariaconsiglia Ferriero

E-Mail Website
Guest Editor
Urology, IRCCS “Regina Elena” National Cancer Institute, Roma, Italy
Interests: robotic surgery; urologic oncology; radical cystectomy; partial nephrectomy; advanced prostate cancer fusion prostate biopsy
Dr. Giuseppe Simone

E-Mail Website1 Website2
Guest Editor
Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Interests: robotic surgery; urologic oncology; radical cystectomy; partial nephrectomy; advanced prostate cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent decades, minimally invasive techniques replaced the open approach in most urologic procedures. The indications have been expanded to fragile patients as well as to challenging cases (such as salvage cystectomy or prostatectomy, high nephrometry score partial nephrectomy, caval thrombectomy, and metastasectomy). More recently, new robotic platforms (single-port and multi-port) have been introduced, showing encouraging results in many urological procedures.

In this Special Issue, we welcome the submission of papers dealing with experiences of laparoscopic and robotic procedures in oncologic and reconstructive surgery (urinary diversion, ureteral reimplantation) as well as techniques for benign disease (simple prostatectomy or nephrolithotomy).

Dr. Mariaconsiglia Ferriero
Dr. Giuseppe Simone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • robotics
  • laparoscopy
  • cystectomy
  • partial nephrectomy
  • prostatectomy

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Published Papers (7 papers)

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Research

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11 pages, 674 KiB  
Article
Impact of No-Clamping Partial Nephrectomy on Early Estimated Glomerular Filtration Rate Preservation
by Piotr Falkowski, Maciej Jaromin, Miłosz Ojdana, Piotr Kutwin and Tomasz Konecki
J. Clin. Med. 2024, 13(18), 5491; https://doi.org/10.3390/jcm13185491 - 16 Sep 2024
Viewed by 697
Abstract
Incidences of kidney cancers are steadily increasing. The surgical resection of renal tumors remains the treatment of choice, and different techniques provide similar oncological outcomes. Minimally invasive methods, especially partial nephrectomy (PN), have emerged as the preferred method of tumor resection, both in [...] Read more.
Incidences of kidney cancers are steadily increasing. The surgical resection of renal tumors remains the treatment of choice, and different techniques provide similar oncological outcomes. Minimally invasive methods, especially partial nephrectomy (PN), have emerged as the preferred method of tumor resection, both in traditional and robot-assisted laparoscopy. PN may be performed as an open or laparoscopic operation. On-clamp PN is a variant of PN that includes the clamping of renal vessels; off-clamp PN is performed without any ischemia. Objectives: To assess the short-term loss of eGFR after on-clamp and off-clamp PN. Methods: Data from 2021 to 2024 were retrospectively collected from a hospital database. The patients included in the study had a diagnosed kidney tumor that was confirmed by MRI or CT imaging. The patients were divided into two groups depending on the type of treatment they received: on-clamp PN or off-clamp PN. Hematocrit (HCT), hemoglobin (Hb) and eGFR were measured and compared. Results: Both groups had comparable preoperative HTC, Hb, and eGFR. eGFR loss 24 h after the procedure was 35.4% lower in the off-clamp group compared to the on-clamp group (p = 0.027). Conclusions: Off-clamp PN is a safe and viable method for kidney tumor resection, both in traditional and robot-assisted laparoscopy. This technique results in a smaller perioperative loss of eGFR, which relates to better short-term functional outcomes than on-clamp PN. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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11 pages, 234 KiB  
Article
Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve
by Francesco Prata, Salvatore Basile, Francesco Tedesco, Alberto Ragusa, Matteo Pira, Andrea Iannuzzi, Marco Fantozzi, Angelo Civitella, Roberto Mario Scarpa and Rocco Papalia
J. Clin. Med. 2024, 13(8), 2226; https://doi.org/10.3390/jcm13082226 - 11 Apr 2024
Viewed by 1169
Abstract
Background/Objectives: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the [...] Read more.
Background/Objectives: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the surgical quality of RAPN with the Hugo™ RAS System (Medtronic, Minneapolis, MN, USA). Methods: Between October 2022 and September 2023, 27 consecutive patients underwent off-clamp RAPN for localized renal tumors at our institution. To analyze the learning curve (LC), the cohort was chronologically divided into two phases of 6 months each. Proficiency was defined as the achievement of trifecta while maintaining a comparable intraoperative time in the interquartile range of laparoscopic partial nephrectomy performed by the same surgeon. A logistic binary regression model was built to identify predictors of proficiency achievement. Results: A proficiency score was achieved in 14 patients (74.1%). At univariable analysis, number of consecutive procedures > 12 (OR 13.7; 95%CI 2.05–21.1, p = 0.007), pathological tumor size (OR 0.92; 95%CI 0.89–0.99, p = 0.04) and essential blood hypertension (OR 0.16; 95%CI 0.03–0.82, p = 0.02) were found to be predictors of proficiency score. At multivariable analysis, after adjusting for potential confounding factors, number of consecutive procedures > 12 (OR 8.1; 95%CI 1.44–14.6, p = 0.03) was the only independent predictor of proficiency score achievement. Conclusions: Our results showed that the skills of an experienced laparoscopic surgeon are transferrable to the novel Hugo™ RAS System in the context of nephron-sparing surgery. Improved surgical quality may be expected after completing the first 12 consecutive procedures. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
10 pages, 692 KiB  
Article
Trifecta Outcomes of Robot-Assisted Partial Nephrectomy Using the New Hugo™ RAS System Versus Laparoscopic Partial Nephrectomy
by Francesco Prata, Alberto Ragusa, Francesco Tedesco, Matteo Pira, Andrea Iannuzzi, Marco Fantozzi, Angelo Civitella, Roberto Mario Scarpa and Rocco Papalia
J. Clin. Med. 2024, 13(7), 2138; https://doi.org/10.3390/jcm13072138 - 7 Apr 2024
Cited by 2 | Viewed by 1201
Abstract
(1) Background: Laparoscopic partial nephrectomy (LPN) is still performed in many referred urological institutions, representing a valid alternative to robot-assisted partial nephrectomy (RAPN). We aimed to compare trifecta outcomes of LPN and RAPN with the Hugo™ RAS System. (2) Methods: Between [...] Read more.
(1) Background: Laparoscopic partial nephrectomy (LPN) is still performed in many referred urological institutions, representing a valid alternative to robot-assisted partial nephrectomy (RAPN). We aimed to compare trifecta outcomes of LPN and RAPN with the Hugo™ RAS System. (2) Methods: Between October 2022 and September 2023, eighty-nine patients underwent minimally invasive partial nephrectomy (group A, RAPN = 27; group B, Laparoscopic PN = 62) for localized renal tumors at our Institution. Continuous variables were presented as median and IQR and compared by means of the Mann–Whitney U test, while categorical variables were presented as frequencies (%) and compared by means of the χ2 test. (3) Results: Group A showed a higher rate of male patients (81.5% vs. 59.7%, p = 0.04) and a higher trend towards larger clinical tumor size (34 vs. 29 mm, p = 0.14). All the other baseline variables were comparable between the two groups (all p > 0.05). Regarding post-operative data, group A displayed a lower operative time (92 vs. 149.5 min, p = 0.005) and a shorter hospital stay (3 vs. 5, p = 0.002). A higher rate of malignant pathology was evidenced in group A (77.8% vs. 58.1%, p = 0.07) as well as a lower trend towards positive surgical margins (3.7% vs. 4.8%, p = 0.82), even if not statistically significant. (4) Conclusions: The rate of trifecta achievement was 92.6% and 82.3% for group A and B (p = 0.10), respectively. In terms of trifecta outcomes, RAPN using the Hugo™ RAS System showed comparable results to LPN performed by the same experienced surgeon. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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11 pages, 5693 KiB  
Article
Interstitial Cells of Cajal and P2X3 Receptors at Ureteropelvic Junction Obstruction and Their Relationship with Pain Response
by Dominika Borselle, Maciej Kaczorowski, Bartosz Gogolok, Dariusz Patkowski, Marcin Polok, Agnieszka Hałoń and Wojciech Apoznański
J. Clin. Med. 2024, 13(7), 2109; https://doi.org/10.3390/jcm13072109 - 4 Apr 2024
Viewed by 914
Abstract
Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal [...] Read more.
Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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9 pages, 2389 KiB  
Article
Retrotrigonal Layer Dissection from a Posterior Approach Enables Bladder Neck Preservation in Robot-Assisted Radical Prostatectomy
by Satoshi Washino, Kimitoshi Saito, Yuhki Nakamura and Tomoaki Miyagawa
J. Clin. Med. 2024, 13(5), 1258; https://doi.org/10.3390/jcm13051258 - 22 Feb 2024
Viewed by 982
Abstract
Background: We developed a novel surgical technique: dissection of the retrotrigonal layer from a posterior approach in robot-assisted radical prostatectomy (RARP). This approach enables earlier access to the posterior space during bladder neck dissection and helps preserve the bladder neck. We evaluated the [...] Read more.
Background: We developed a novel surgical technique: dissection of the retrotrigonal layer from a posterior approach in robot-assisted radical prostatectomy (RARP). This approach enables earlier access to the posterior space during bladder neck dissection and helps preserve the bladder neck. We evaluated the safety and efficacy of this technique in terms of bladder neck preservation Methods: We retrospectively reviewed 238 consecutive patients who underwent RARP using this technique from August 2021 to September 2023. Key metrics included the success rate of accessing the posterior space prior to bladder neck opening during the dissection and the rate of bladder neck preservation. In addition, oncological and surgical safety, as well as continence recovery, were assessed. Results: The median age and prostate-specific antigen level were 72 (65–75) years and 7.35 (5.40–11.5) ng/mL, respectively. In 153 (64%) patients, the posterior space was successfully accessed before bladder neck opening, with the success rate increasing from 56% in the series’ first half to 72% in the second half (p = 0.015). The bladder neck was preserved in 120 (53%) patients, and this rate increased from 39% in the first half to 63% in the second half (p = 0.0004). Positive surgical margins at the junction between the prostate and bladder were observed in 10 cases (4%). Bladder neck preservation correlated with early continence recovery (hazard ratio 1.37 [95% confidence interval 1.03–1.83], p = 0.030). The grade 3 complication associated with this technique occurred in one case (0.5%). Conclusion: Retrotrigonal layer dissection from a posterior approach in RARP enhances the safety and ease of bladder neck dissection and aids in its preservation, potentially leading to improved continence recovery. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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Review

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13 pages, 610 KiB  
Review
Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient
by Flavia Proietti, Rocco Simone Flammia, Leslie Claire Licari, Eugenio Bologna, Umberto Anceschi, Maria Consiglia Ferriero, Gabriele Tuderti, Riccardo Mastroianni, Aldo Brassetti, Giuseppe Simone and Costantino Leonardo
J. Clin. Med. 2024, 13(6), 1590; https://doi.org/10.3390/jcm13061590 - 10 Mar 2024
Viewed by 1555
Abstract
(1) Background: Simulation-based training has revolutionized surgical education, providing a solution to the changing demands of surgical training and performance. The increasing demand for standardized training in robotic surgery has accelerated the adoption of simulation-based training as a necessary component of modern surgical [...] Read more.
(1) Background: Simulation-based training has revolutionized surgical education, providing a solution to the changing demands of surgical training and performance. The increasing demand for standardized training in robotic surgery has accelerated the adoption of simulation-based training as a necessary component of modern surgical education. This study examines the existing literature on training approaches employed in robot-assisted urological surgery; (2) Methods: The authors conducted a standardized search of online databases. Upon collecting the articles, the authors assessed their relevance and content before proceeding with the drafting of the text; (3) Results: The use of simulators is supported by convincing evidence that shows an advantage in the acquisition of robotic skills. Urological societies have created detailed training programs for robotic surgery that guide beginners through the entire process of skill acquisition; (4) Conclusions: The future landscape for robotic urology training is likely to involve organized, obligatory, and centralized training, which may be overseen by urologic associations. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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Other

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13 pages, 1699 KiB  
Systematic Review
Urological Complications in Radical Surgery for Cervical Cancer: A Comparative Meta-Analysis before and after LACC Trial
by Valentina Bruno, Benito Chiofalo, Alessandra Logoteta, Gabriella Brandolino, Delia Savone, Mario Russo, Isabella Sperduti, Emanuela Mancini, Luana Fabrizi, Umberto Anceschi and Enrico Vizza
J. Clin. Med. 2023, 12(17), 5677; https://doi.org/10.3390/jcm12175677 - 31 Aug 2023
Viewed by 1289
Abstract
Background: After the LACC trial publication in 2018, the minimally invasive approach (MIS) has severely decreased in favor of open surgery: MIS radical hysterectomy was associated with worse oncological outcomes than open surgery, but urological complications were never extensively explored in pre- versus [...] Read more.
Background: After the LACC trial publication in 2018, the minimally invasive approach (MIS) has severely decreased in favor of open surgery: MIS radical hysterectomy was associated with worse oncological outcomes than open surgery, but urological complications were never extensively explored in pre- versus post-LACC eras, even if they had a great impact on post-operative QoL. The purpose of this meta-analysis is to compare functional and organic urological complication rates before and after LACC trial. Methods: An independent search of the literature was conducted 4 years before and after the LACC trial and 50 studies were included. Results: The overall rate of urologic complications was higher in pre-LACC studies while no differences were found for organic urological complications. Conversely, the overall risk of dysfunctional urological complications showed a higher rate in the pre-LACC era. This is probably related to a sudden shift to open surgery, with potential lower thermal damage to the urinary tract autonomic nervous fibers. Conclusions: This meta-analysis showed that the incidence of urological complications in radical cervical cancer surgery was higher before the LACC trial, potentially due to the shift to open surgery. Nevertheless, further studies are needed to shed light on the connection between minimally invasive surgery and urological damage. Full article
(This article belongs to the Special Issue Advances in Laparoscopic and Robotic Surgery in Urology)
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