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Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations
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Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: closed (31 January 2026) | Viewed by 5736

Special Issue Editors

Prof. Dr. Alchiede Simonato

E-Mail Website
Guest Editor
Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy
Interests: urology; oncologic surgery; robotic surgery; laparoscopy; prostate; bladder; kidney; penis; testis
Special Issues, Collections and Topics in MDPI journals
Dr. Nicola Pavan

E-Mail Website
Guest Editor
Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy
Interests: prostate cancer; bladder cancer; kidney cancer; robotic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Minimally invasive surgery (MIS) has emerged as a transformative approach in the treatment of urological cancers. This Special Issue delves into the innovative techniques and outcomes associated with MIS in urological oncology. MIS, including laparoscopy and robotic-assisted procedures, offers numerous advantages, such as reduced blood loss, shorter hospital stays, and faster recovery times compared to traditional open surgeries. The articles in this Special Issue explore the application of MIS in the management of various urological cancers, including prostate, kidney, bladder, and testicular cancers. Additionally, they investigate the long-term oncological outcomes, patient quality of life, and cost-effectiveness of MIS. By showcasing the latest research and clinical experiences, this Special Issue aims to advance our understanding of the role of MIS in improving patient outcomes and reshaping the landscape of urological cancer treatment.

Prof. Dr. Alchiede Simonato
Dr. Nicola Pavan
Guest Editors

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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. Cancers 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 2900 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

  • minimally invasive
  • robotic
  • laparoscopic
  • uro-oncology
  • prostate cancer
  • bladder cancer
  • kidney cancer
  • testicular cancers
  • quality of life
  • penile cancer

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Published Papers (5 papers)

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Research

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16 pages, 1199 KB  
Article
Percutaneous Microwave Ablation Preserves Renal Function with Similar Long Term Oncologic Outcomes Compared to Surgery for Clinical T1 Renal Cell Carcinoma
by Daniel F. Roadman, Daniel D. Shapiro, Arighno Das, Leslie W. Nelson, Paz Lotan, Michael C. Risk, Kyle A. Richards, Elizabeth L. Koehne, David F. Jarrard, Fred T. Lee, Jr., Glenn O. Allen, Edwarda Golden, Tim Ziemlewicz, James Louis Hinshaw and Edwin Jason Abel
Cancers 2026, 18(2), 334; https://doi.org/10.3390/cancers18020334 - 21 Jan 2026
Viewed by 682
Abstract
Background/Objectives: Percutaneous microwave (MW) ablation is a nephron sparing treatment for localized renal cell carcinoma (RCC). We compared perioperative, renal functional, and oncologic outcomes for clinical stage 1 RCC treated with MW ablation, PN, or RN. Methods: Adults with clinical T1 kidney masses [...] Read more.
Background/Objectives: Percutaneous microwave (MW) ablation is a nephron sparing treatment for localized renal cell carcinoma (RCC). We compared perioperative, renal functional, and oncologic outcomes for clinical stage 1 RCC treated with MW ablation, PN, or RN. Methods: Adults with clinical T1 kidney masses treated with MW ablation, PN, or RN from 2001–2025 were identified. Outcomes included: 90-day overall and major complication rate, 30-day readmission rate, length of hospital stay (LOS), change in renal function, local recurrence-free survival (LRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Univariable and multivariable analyses evaluated outcomes adjusted for confounders. Results: A total of 2201 patients with renal masses ≤ 7 cm and no evidence of locally advanced or metastatic disease were treated with MW ablation (708), PN (729), or RN (764). MW ablation patients were older and more comorbid compared to both PN/RN, whereas RN patients had larger, higher-grade tumors. Ninety-day overall complications were lowest after MW ablation (8.9% vs. 20.3% PN, p < 0.001 and 8.9% vs. 19.9% RN, p < 0.001). LOS was shortest after MW ablation (median 1 day vs. 3 days PN/RN, p < 0.001 for each). Six-month eGFR decline was similar after MW ablation and PN (−5.2% and −4.7%, p = 0.84) but greater after RN (−32.9%, p < 0.001). Local recurrences were more common with MW ablation, with five-year LRFS 96.4% versus 99.7% for PN (p < 0.001). Five-year MFS (99.5% vs. 99.7%, p = 0.24) and CSS (99.3% vs. 99.7%, p = 0.71) did not differ between MW ablation and PN. Conclusions: Percutaneous MW ablation has comparable metastasis free and cancer specific survival with lower perioperative morbidity and comparable renal preservation to PN, despite worse baseline comorbidity and renal function. These findings support MW ablation as an effective nephron-sparing option for appropriately selected patients with clinical T1 RCC when performed at an experienced center. Full article
(This article belongs to the Special Issue Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations)
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17 pages, 773 KB  
Article
Off-Clamp Robotic-Assisted Partial Nephrectomy: Retrospective Comparative Analysis from a Large Italian Multicentric Series
by Angelo Porreca, Filippo Marino, Davide De Marchi, Marco Giampaoli, Francesca Simonetti, Antonio Amodeo, Paolo Corsi, Francesco Claps, Daniele Romagnoli, Alessandro Crestani and Luca Di Gianfrancesco
Cancers 2025, 17(16), 2645; https://doi.org/10.3390/cancers17162645 - 13 Aug 2025
Viewed by 1727
Abstract
Objective: To evaluate the perioperative outcomes, functional impact, and oncologic efficacy of off-clamp robotic-assisted partial nephrectomy (RAPN) in patients with renal masses across multiple high-volume centers. Materials and Methods: We conducted a retrospective multicenter study including 563 patients (group 1) who underwent clampless [...] Read more.
Objective: To evaluate the perioperative outcomes, functional impact, and oncologic efficacy of off-clamp robotic-assisted partial nephrectomy (RAPN) in patients with renal masses across multiple high-volume centers. Materials and Methods: We conducted a retrospective multicenter study including 563 patients (group 1) who underwent clampless RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors >7 cm, or prior renal surgery were excluded. The standardized surgical technique involved tumor resection without clamping of the renal artery, followed by the use of hemostatic agents and standard/selective suturing of the resection bed on demand. Patients in group 1 were compared to 244 consecutive patients treated in the same centres and treated with RAPN with an on-clamp procedure (group 2). Primary outcomes included operative time, blood loss, and complications, while secondary outcomes assessed renal function preservation and oncologic control at an at least 12-month follow-up. Results: The median operative time was 118 min (IQR: 100–140 min), and median estimated blood loss was 150 mL (range: 50–400 mL). The overall complication rate was 9.2%, with most classified as Clavien–Dindo Grade I–II. No intraoperative conversions to open surgery were recorded. Renal function was well preserved, with a median estimated glomerular filtration rate (eGFR) decline of 4.1% at three months (p > 0.05), and no cases of acute kidney injury. Oncologic outcomes were favorable, with a positive surgical margin rate (PSM) of 2.4% and two cases of tumor recurrences (0.36%) documented at a 12-month follow-up. Conclusions: The off-clamp RAPN is a safe and effective nephron-sparing approach, offering significant renal function preservation while maintaining oncologic efficacy. This technique minimizes ischemia–reperfusion injury and post-surgical fibrosis, providing a viable alternative to on-clamp RAPN. Further prospective trials are warranted to confirm long-term benefits and refine patient selection criteria. Full article
(This article belongs to the Special Issue Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations)
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12 pages, 249 KB  
Article
Efficient Implementation of a Robot-Assisted Radical Cystectomy Program in a Naïve Centre Experienced in Open Radical Cystectomy and Other Robot-Assisted Surgeries: A Comparative Analysis of Perioperative Outcomes and Complications
by Gianluca Giannarini, Gioacchino De Giorgi, Maria Abbinante, Carmine Franzese, Jeanlou Collavino, Fabio Traunero, Marco Buttazzi, Antonio Amodeo, Angelo Porreca and Alessandro Crestani
Cancers 2025, 17(15), 2532; https://doi.org/10.3390/cancers17152532 - 31 Jul 2025
Cited by 3 | Viewed by 1029
Abstract
Background/Objectives: While robot-assisted radical cystectomy (RARC) has shown potential benefits over open radical cystectomy (ORC), such as reduced blood loss and quicker recovery, its adoption has been limited because of its complexity and long learning curve, especially for urinary diversion. We assessed whether [...] Read more.
Background/Objectives: While robot-assisted radical cystectomy (RARC) has shown potential benefits over open radical cystectomy (ORC), such as reduced blood loss and quicker recovery, its adoption has been limited because of its complexity and long learning curve, especially for urinary diversion. We assessed whether a RARC program with fully intracorporeal urinary diversion could be safely implemented in a hospital with no prior experience in RARC, but with expertise in ORC and other robotic surgeries. We also compared perioperative outcomes and complications between RARC and ORC during the implementation phase. Methods: This retrospective comparative study included 50 consecutive patients who underwent RARC between June 2023 and January 2025 and 50 patients previously treated with ORC. All RARC cases were performed with intracorporeal urinary diversion. A structured proctoring program guided two surgeons through a stepwise training approach by an expert RARC surgeon. Perioperative outcomes and 90-day complications were compared. Results: All RARC procedures were completed fully intracorporeally with no conversions to open surgery. Compared with ORC, RARC was associated with significantly shorter operative times (for ileal conduit diversion) and hospital stays, lower estimated blood loss, and fewer postoperative complications. There were no differences in intraoperative complications. Worst single grade ≥ 3 complications were significantly less frequent in the RARC than the ORC group (11 [11%] versus 21 [21%], p = 0.045). On multivariable analysis, the robotic approach independently predicted fewer any-grade complications (odds ratio 0.81, 95% confidence intervals 0.65–0.95, p = 0.01). Conclusions: A RARC program can be safely and effectively implemented in a previously RARC-naïve centre with existing surgical expertise. The robotic approach offers clear perioperative benefits and may represent a favourable alternative to open surgery. Full article
(This article belongs to the Special Issue Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations)
10 pages, 459 KB  
Article
A Closer Look at Radiation Exposure During Percutaneous Cryoablation for T1 Renal Tumors
by Luna van den Brink, Michaël M. E. L. Henderickx, Otto M. van Delden, Harrie P. Beerlage, Daniel Martijn de Bruin and Patricia J. Zondervan
Cancers 2025, 17(12), 2016; https://doi.org/10.3390/cancers17122016 - 17 Jun 2025
Viewed by 1063
Abstract
Introduction: Percutaneous cryoablation (PCA) can be a valid alternative to partial nephrectomy for patients with cT1a renal tumors. A potential disadvantage of PCA is radiation exposure for patients, though the exact significance of this is unknown. This study aims to uncover the degree [...] Read more.
Introduction: Percutaneous cryoablation (PCA) can be a valid alternative to partial nephrectomy for patients with cT1a renal tumors. A potential disadvantage of PCA is radiation exposure for patients, though the exact significance of this is unknown. This study aims to uncover the degree of radiation exposure during PCA and what factors are of influence. Methods: This is a retrospective analysis of a prospectively maintained database of patients who underwent CT-guided PCA for cT1 renal cell carcinoma (RCC) between January 2014 and September 2024. The median effective dose (mSV) of PCA was calculated and compared to the expected cumulative radiation exposure during follow-up. Multivariate linear regression was performed to identify factors predictive of higher radiation exposure (mSV). Results: A total of 164 PCAs were performed, with radiation data available for 133 cases. Mean age was 65 (±11) years and the mean tumor diameter was 28 (±9.6) mm. Median effective dose of the CA procedures was 26 mSV (IQR 18–37). The estimated cumulative effective dose of follow-up CT scans according to 2016 and 2024 European Association of Urology guidelines was 158 (IQR 117–213) and 105 mSV (IQR 78–142), respectively. Multivariate linear regression analysis identified BMI (OR 1.723, p < 0.001), the number of needles used (OR 4.060, p < 0.001), and the necessity for additional procedures (OR 8.056, p < 0.001) as significant predictors of a higher effective dose. Conclusions: We found a median effective dose of 26 mSV for PCA, which is relatively low compared to the cumulative radiation exposure associated with CT scans during follow-up of patients post-ablation according to the guidelines. Furthermore, increased BMI, a higher number of required needles and the execution of additional procedures are all associated with a higher effective dose. Full article
(This article belongs to the Special Issue Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations)
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Review

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17 pages, 460 KB  
Review
Nerve-Sparing in High-Risk Prostate Cancer: Advantages and Pitfalls of Current Strategies and Technologies
by Daniele Robesti, Pierluigi Russo, Giuseppe Fallara, Fernando Blank, Massimo Valerio, Ashutosh K. Tewari, Francesco Montorsi, Guillaume Ploussard, Nilesh Patil and Alberto Martini
Cancers 2026, 18(6), 945; https://doi.org/10.3390/cancers18060945 - 13 Mar 2026
Viewed by 777
Abstract
Background and Objective: Positive surgical margins (PSMs) remain a major challenge during radical prostatectomy, particularly in patients with high-risk prostate cancer (HR-PCa), where extracapsular extension, multifocal disease, and aggressive tumor biology substantially increase the likelihood of incomplete resection. In this setting, PSMs [...] Read more.
Background and Objective: Positive surgical margins (PSMs) remain a major challenge during radical prostatectomy, particularly in patients with high-risk prostate cancer (HR-PCa), where extracapsular extension, multifocal disease, and aggressive tumor biology substantially increase the likelihood of incomplete resection. In this setting, PSMs are strongly associated with early biochemical recurrence and frequently prompt adjuvant or salvage treatments, potentially exposing patients to overtreatment and added morbidity. Materials and Methods: To review and critically appraise established and emerging intraoperative technologies for surgical margin assessment during radical prostatectomy, with a specific focus on their potential role and relevance in patients with HR-PCa. Evidence Acquisition: A non-systematic literature review was performed using Pubmed, MEDLINE, Web of Science, and Google Scholar, focusing on preoperative, intraoperative ex vivo, and intraoperative in vivo technologies for margin assessment. Emphasis was placed on techniques with potential applicability to HR-PCa, where real-time intraoperative decision-making is particularly consequential. Evidence Synthesis: Preoperative tools, including multiparametric MRI, PSMA-PET imaging, and predictive nomograms, aid surgical planning but show limited sensitivity for microscopic extracapsular extension, especially in high-risk disease. Intraoperative frozen section analysis reduces positive surgical margin rates while enabling selective nerve-sparing (defined as a side-specific, risk-adapted preservation strategy); however, its widespread adoption is constrained by substantial logistical and resource requirements, and robust oncological outcome data in high-risk populations remain limited. Novel ex vivo approaches, such as fluorescence confocal microscopy and specimen-based PSMA PET/CT imaging, offer rapid whole-gland or targeted margin assessment with reduced dependency on dedicated pathology workflows. In parallel, emerging in vivo technologies, particularly PSMA-targeted near-infrared-fluorescence-guided surgery, enable real-time detection of residual tumor and facilitate selective re-resection, representing a biology-driven approach that may be especially suited to HR-PCa. Conclusions: In high-risk prostate cancer, intraoperative margin assessment technologies may extend beyond functional preservation and play a central role in optimizing oncological radicality and multimodal treatment sequencing. While NeuroSAFE remains the reference standard, PSMA-based ex vivo and in vivo technologies are particularly promising in HR-PCa due to their ability to integrate tumor biology into surgical decision-making. Prospective studies focusing on high-risk-specific oncological and patient-reported outcomes are needed before widespread clinical implementation. Full article
(This article belongs to the Special Issue Minimally Invasive Approaches in Urological Oncology: Current Trends and Innovations)
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