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14 pages, 761 KiB

Open AccessArticle

Robot-Assisted Radical Nephroureterectomy: A Safe and Effective Option for Upper Tract Urothelial Carcinoma, Especially for Novice Surgeons

by Chia-Lun Chang, Chung-You Tsai, Pai-Yu Cheng, Wen-Jeng Wu and Yao-Chou Tsai

Cancers 2025, 17(9), 1394; https://doi.org/10.3390/cancers17091394 - 22 Apr 2025

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Abstract

Background: Radical nephroureterectomy (RNU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive techniques like robotic (RARNU) and laparoscopic (LRNU) RNU offer potential benefits over open surgery, but their comparative oncologic outcomes are debated. Methods: This retrospective, multicenter study analyzed [...] Read more.

Background: Radical nephroureterectomy (RNU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive techniques like robotic (RARNU) and laparoscopic (LRNU) RNU offer potential benefits over open surgery, but their comparative oncologic outcomes are debated. Methods: This retrospective, multicenter study analyzed 2037 Taiwanese patients undergoing RNU between 2010 and 2022. Missing data was addressed using multiple imputations. Overlap weighting was applied to balance patient characteristics between the RARNU and LRNU groups. Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. Results: After excluding the missing data, 405 patients underwent RARNU, and 1262 underwent LRNU. After adjusting for baseline differences, both groups showed comparable rates of surgical complications, residual tumor, UTUC-related mortality, and disease recurrence. The median follow-up was similar (52.4 vs. 51.6 months, p = 0.91). Using Kaplan-Meier survival curve analysis, overall survival, cancer-specific survival, and disease-free survival were similar between the two groups. Conclusions: This study shows that RARNU for UTUC has comparable oncological and perioperative outcomes to pure LRNU. RARNU may be easier for surgeons to adopt, particularly those with limited laparoscopic experience. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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14 pages, 775 KiB

Open AccessArticle

Minimally Invasive One-Docking, Two-Target, and Three-Port Robotic-Assisted Nephroureterectomy: Redefining Surgical Approach

by Yarden Zohar, Ben Hefer, Itay Vazana, Muhammad H. Jabareen, Rabea Moed, Elad Mazor, Emilio Charabati, Nimer Alsaraia and Nicola J. Mabjeesh

Cancers 2025, 17(4), 627; https://doi.org/10.3390/cancers17040627 - 13 Feb 2025

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Abstract

Objective: Nephroureterectomy (NU) is a challenging multi-quadrant surgical procedure that involves intra–infra- and retroperitoneal dissection. The introduction of the da Vinci Xi platform has further improved the minimally invasive approach. With the Xi robotic system, single docking for multi-quadrant dissection is now feasible [...] Read more.

Objective: Nephroureterectomy (NU) is a challenging multi-quadrant surgical procedure that involves intra–infra- and retroperitoneal dissection. The introduction of the da Vinci Xi platform has further improved the minimally invasive approach. With the Xi robotic system, single docking for multi-quadrant dissection is now feasible and increasingly popular. Herein, we redefined the surgical technique by optimizing minimal port usage, maximizing template visualization, and utilizing the Xi platform’s retargeting system, based on our experience with 15 patients. Methods: This single-center cohort study was based on the experience of a single surgeon with 15 patients who underwent robotic radical nephroureterectomy (RRNU) between 2019 and 2024, performed via the one docking, three-port technique. Patient data were retrospectively collected and analyzed from the medical records. Results: The cohort’s median age was 79 years, with male predominance of 80%. The median operative time was 133 min, with 60% of procedures completed within 150 min; longer times (>150 min) were due to additional intraoperative non-robotic procedures. Median blood loss was 100 mL, with two patients requiring intraoperative blood transfusion. Lymph node dissection (LND) in six patients did not significantly affect the overall operative time. The intraoperative and major postoperative complication rates (Clavien-Dindo grade > III) were 13.3%. Conclusions: The use of three robotic ports combined with the Xi platform’s camera-hop feature is a safe and effective technique for multi-quadrant, minimally invasive procedures, particularly in RRNU. This approach facilitates procedural goals and reduces overall operative time. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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11 pages, 1884 KiB

Open AccessArticle

Local Endoscopic Treatment of Low-Grade Urothelial Tumors in the Upper Urinary Tract—Oncological Outcome of a Consecutive Single-Center Series of 118 Patients

by Sophie Bislev, Simone Buchardt Brandt, Sven Fuglsig and Jørgen Bjerggaard Jensen

Cancers 2024, 16(22), 3795; https://doi.org/10.3390/cancers16223795 - 11 Nov 2024

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Abstract

Background: Upper urinary tract urothelial tumors are mostly treated with the use of endoscopic laser ablation. The treatment is recommended when the tumor is low grade and non-invasive. Objective: The aim of the present study was to investigate the oncological outcome of patients [...] Read more.

Background: Upper urinary tract urothelial tumors are mostly treated with the use of endoscopic laser ablation. The treatment is recommended when the tumor is low grade and non-invasive. Objective: The aim of the present study was to investigate the oncological outcome of patients treated endoscopically for low-grade (LG) upper tract urothelial carcinoma (UTUC). Methods: One hundred and eighteen consecutive patients with pTa LG UTUC initially treated with laser ablation from 2012–2022 at a single university hospital were included. Patient and tumor characteristics, treatment, and oncological outcomes were retrospectively registered from electronic medical journals. Survival analysis was performed using Kaplan–Meier and Nelson–Aalen plots. Results: The median number of local recurrences was 2 with a median time to first recurrence of 5 months (IQR: 2–46). The 2-year share of patients having no recurrence was 28.8%. The risk of recurrence was highest within the first 3 years following initial treatment. Two-year survival function with no progression and preserved renal unit was 67.9%. The two-year overall survival (OS) and disease-specific survival (DSS) were 84.2% and 97.1%. The 5-year OS and DSS were 59.1% and 94.1%. The median follow-up time for OS was 36 months (IQR: 20.3–58.8). Conclusions: In the patient series, we found that the risk of recurrence following laser ablation of LG UTUC was high; however, it was associated with a low risk of progression and high OS and DSS. Therefore, we conclude that treatment with laser ablation in patients with LG UTUC is safe, although frequent follow-up is needed to detect recurrence. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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10 pages, 245 KiB

Open AccessArticle

High BMI and Surgical Time Are Significant Predictors of Lymphocele after Robot-Assisted Radical Prostatectomy

by Simon Gloger, Christian Wagner, Sami-Ramzi Leyh-Bannurah, Stefan Siemer, Madeleine Arndt, Jens-Uwe Stolzenburg, Toni Franz and Burkhard Ubrig

Cancers 2023, 15(9), 2611; https://doi.org/10.3390/cancers15092611 - 4 May 2023

Cited by 6 | Viewed by 2041

Abstract

Lymphoceles (LC) occur in up to 60% after robot-assisted radical prostatectomy (RARP) and pelvic lymphadenectomy (PLND). In 2–10%, they are symptomatic and may cause complications and require treatment. Data on risk factors for the formation of lymphoceles after RARP and PNLD remain sparse [...] Read more.

Lymphoceles (LC) occur in up to 60% after robot-assisted radical prostatectomy (RARP) and pelvic lymphadenectomy (PLND). In 2–10%, they are symptomatic and may cause complications and require treatment. Data on risk factors for the formation of lymphoceles after RARP and PNLD remain sparse in the urologic literature and are inconclusive to date. The underlying data of this secondary analysis were obtained from the prospective multi-center RCT ProLy. We performed a multivariate analysis to focus on the potential risk factors that may influence lymphocele formation. Patients with LC had a statistically significant higher BMI (27.8 vs. 26.3 kg/m², p < 0.001; BMI ≥ 30 kg/m²: 31 vs. 17%, p = 0.002) and their surgical time was longer (180 vs. 160 min, p = 0.001) In multivariate analysis, the study group (control vs. peritoneal flap, p = 0.003), BMI (metric, p = 0.028), and surgical time (continuous, p = 0.007) were independent predictors. Patients with symptomatic lymphocele presented with higher BMI (29 vs. 26.6 kg/m², p = 0.007; BMI ≥ 30 kg/m²: 39 vs. 20%, p = 0.023) and experienced higher intraoperative blood loss (200 vs. 150 mL, p = 0.032). In multivariate analysis, BMI ≥ 30 kg/m² vs. < 30 kg/m² was an independent predictor for the formation of a symptomatic lymphocele (p = 0.02). High BMI and prolonged surgical time are general risk factors for the development of LC. Patients with a BMI ≥ 30 kg/m² had a higher risk for symptomatic lymphoceles. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

10 pages, 474 KiB

Open AccessArticle

Last Resort from Nursing Shortage? Comparative Cost Analysis of Open vs. Robot-Assisted Partial Nephrectomies with a Focus on the Costs of Nursing Care

by Philip Zeuschner, Carolin Böttcher, Lutz Hager, Johannes Linxweiler, Michael Stöckle and Stefan Siemer

Cancers 2023, 15(8), 2291; https://doi.org/10.3390/cancers15082291 - 14 Apr 2023

Cited by 4 | Viewed by 2740

Abstract

Despite perioperative advantages, robot-assisted surgery is associated with high costs. However, the lower morbidity of robotic surgery could lead to a lower nursing workload and cost savings. In this comparative cost analysis of open retroperitoneal versus robot-assisted transperitoneal partial nephrectomies (PN), these possible [...] Read more.

Despite perioperative advantages, robot-assisted surgery is associated with high costs. However, the lower morbidity of robotic surgery could lead to a lower nursing workload and cost savings. In this comparative cost analysis of open retroperitoneal versus robot-assisted transperitoneal partial nephrectomies (PN), these possible cost savings, including other cost factors, were quantified. Therefore, patient, tumor characteristics, and surgical results of all PN within two years at a tertiary referral center were retrospectively analyzed. The nursing effort was quantified by the local nursing staff regulation and INPULS^® intensive care and performance-recording system. Out of 259 procedures, 76.4% were performed robotically. After propensity score matching, the median total nursing time (2407.8 vs. 1126.8 min, p < 0.001) and daily nursing effort (245.7 vs. 222.6 min, p = 0.025) were significantly lower after robotic surgery. This resulted in mean savings of EUR 186.48 in nursing costs per robotic case, in addition to savings of EUR 61.76 due to less frequent administrations of erythrocyte concentrates. These savings did not amortize the higher material costs for the robotic system, causing additional expenses of EUR 1311.98 per case. To conclude, the nursing effort after a robotic partial nephrectomy was significantly lower compared to open surgery; however, this previously unnoticed savings mechanism alone could not amortize the overall increased costs. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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10 pages, 569 KiB

Open AccessArticle

Sutureless Purely Off-Clamp Robot-Assisted Partial Nephrectomy: Avoiding Renorrhaphy Does Not Jeopardize Surgical and Functional Outcomes

by Aldo Brassetti, Leonardo Misuraca, Umberto Anceschi, Alfredo Maria Bove, Manuela Costantini, Maria Consiglia Ferriero, Salvatore Guaglianone, Riccardo Mastroianni, Giulia Torregiani, Marco Covotta, Gabriele Tuderti and Giuseppe Simone

Cancers 2023, 15(3), 698; https://doi.org/10.3390/cancers15030698 - 23 Jan 2023

Cited by 13 | Viewed by 2007

Abstract

To compare outcomes of sutureless (SL) vs. renorrhaphy (RR) off-clamp robotic partial nephrectomy (ocRPN), we retrospectively analyzed procedures performed at our center, from January 2017 to April 2021, for cT1-2N0M0 renal masses. All the patients with a minimum follow-up < 1 month were [...] Read more.

To compare outcomes of sutureless (SL) vs. renorrhaphy (RR) off-clamp robotic partial nephrectomy (ocRPN), we retrospectively analyzed procedures performed at our center, from January 2017 to April 2021, for cT1-2N0M0 renal masses. All the patients with a minimum follow-up < 1 month were excluded from the analysis. The trifecta rate defined surgical quality. Any worsening from chronic kidney disease (CKD) I-II to ≧ IIIa (from IIIa to ≧ IIIb, and from IIIb to ≧ IV) was considered as significant stage migration (sCKDsm). A 1:1 propensity score-matched (PSM) analysis minimized baseline imbalances between SL and RR cohorts in terms of age, gender, ASA score, baseline estimated glomerular filtration rate (eGFR), tumor size, and RENAL score. Logistic regression analyses identified predictors of trifecta achievement. Kaplan–Meier (KM) analysis assessed the impact of RR on significant chronic kidney disease sCKDsm-free survival (SMFS), while Cox regression analyses identified its predictors. Overall, 531 patients were included, with a median tumor size of 3.5 cm (IQR: 2.7–5); 70 (13%) presented with a cT2 mass. An SL approach was pursued in 180 cases, but 10 needed conversion to RR. After PSM analysis, patients receiving SL showed a higher trifecta rate (94% vs. 84%; p = 0.007). SMFS probabilities were comparable at KM analysis (log-rank = 0.69). Age (OR: 0.97; 95%CI: 0.95–0.99; p = 0.01), a RENAL score ≧ 10 (OR: 0.29; 95%CI: 0.15–0.57; p < 0.001), and RR (OR: 0.34; 95%CI: 0.17–0.67; p = 0.002) were independent predictors of trifecta achievement. Age (OR: 1.04; 95%CI: 1.003–1.07; p = 0.03) and baseline eGFR (OR: 0.99; 95%CI: 0.97–0.99; p = 0.05) independently predicted sCKDsm. Compared to RR, our experience seems to show that the SL approach significantly increased the probabilities of achieving the trifecta in the observed group of cases. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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9 pages, 783 KiB

Open AccessArticle

Comparison of Clinical Outcomes between Robot-Assisted Partial Nephrectomy and Cryoablation in Elderly Patients with Renal Cancer

by Shohei Kawaguchi, Kouji Izumi, Renato Naito, Suguru Kadomoto, Hiroaki Iwamoto, Hiroshi Yaegashi, Takahiro Nohara, Kazuyoshi Shigehara, Kotaro Yoshida, Yoshifumi Kadono and Atsushi Mizokami

Cancers 2022, 14(23), 5843; https://doi.org/10.3390/cancers14235843 - 26 Nov 2022

Cited by 7 | Viewed by 1654

Abstract

Advances in imaging technologies have increased the opportunities for treating small-diameter renal cell carcinomas (RCCs) in the elderly. This retrospective study based on real-world clinical practice compared perioperative complications, preoperative and postoperative renal function, recurrence-free survival, and overall survival in elderly patients with [...] Read more.

Advances in imaging technologies have increased the opportunities for treating small-diameter renal cell carcinomas (RCCs) in the elderly. This retrospective study based on real-world clinical practice compared perioperative complications, preoperative and postoperative renal function, recurrence-free survival, and overall survival in elderly patients with RCC who had undergone robot-assisted partial nephrectomy (RAPN) or percutaneous cryoablation (PCA). A total of 99 patients (aged ≥70 years), including 50 and 49 patients in the RAPN and PCA groups, respectively, were analyzed. In the entire cohort, Clavien–Dindo grade ≥3 complications occurred in only one patient who had undergone RAPN. Renal function was significantly lower in the postoperative period than in the preoperative period in both the RAPN and PCA groups. The recurrence-free survival and overall survival rates were worse in the PCA group than in the RAPN group, albeit not significantly. RAPN was considered a safe and effective method for treating RCCs in elderly patients. Moreover, although the recurrence rate was slightly higher in the PCA group than in the RAPN group, PCA was deemed to be a safe alternative, especially for treating patients in whom general anesthesia poses a high risk. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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11 pages, 2091 KiB

Open AccessArticle

Does Bladder Cancer with Inchworm Sign Indicate Better Prognosis after TURBT?

by Ryunosuke Nakagawa, Kouji Izumi, Renato Naito, Suguru Kadomoto, Hiroaki Iwamoto, Hiroshi Yaegashi, Shohei Kawaguchi, Takahiro Nohara, Kazuyoshi Shigehara, Kotaro Yoshida, Yoshifumi Kadono and Atsushi Mizokami

Cancers 2022, 14(23), 5767; https://doi.org/10.3390/cancers14235767 - 23 Nov 2022

Cited by 1 | Viewed by 1843

Abstract

Background: Inchworm sign is considered to be a characteristic finding in non-muscle invasive bladder cancer (NMIBC). Nevertheless, pathologically diagnosed muscle invasive bladder cancers (MIBCs) are occasionally diagnosed from tissue obtained by transurethral resection of bladder tumor (TURBT) in patients with inchworm sign. Methods: [...] Read more.

Background: Inchworm sign is considered to be a characteristic finding in non-muscle invasive bladder cancer (NMIBC). Nevertheless, pathologically diagnosed muscle invasive bladder cancers (MIBCs) are occasionally diagnosed from tissue obtained by transurethral resection of bladder tumor (TURBT) in patients with inchworm sign. Methods: We retrospectively investigated the factors related to muscle invasive status in bladder cancer associated with inchworm sign and the role of inchworm sign in tumor outcomes following TURBT. Results: Of the 109 patients with inchworm sign, 94 (86.2%) and 15 (13.8%) were NMIBC and MIBC, respectively. Non-papillary tumors (hazard ratio (HR): 9.55, 95% confidence interval (CI): 2.07–44.10; p < 0.01) and tumors located in the bladder neck (HR: 7.73, 95% CI: 1.83–32.76; p < 0.01) were significant predictors of MIBC in bladder cancer with inchworm sign. Furthermore, recurrence-free survival (RFS) and progression-free survival were compared between patients with NMIBC with and without inchworm sign; however, no significant differences were found. In patients with NMIBC with inchworm sign, positive urine cytology was a prognostic factor for RFS (HR: 1.90, 95% CI: 1.04–3.48; p = 0.04). Conclusions: In bladder cancer with inchworm sign, 86.2% were NMIBC. Even in the case of inchworm sign, the presence of a non-papillary tumor or a bladder neck tumor before TURBT should be noted because of the possibility of MIBC. In this study, the inchworm sign was not a prognostic factor in patients with NMIBC. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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Review

Jump to: Research, Other

27 pages, 9590 KiB

Open AccessReview

Posterior Retroperitoneal Laparoscopic Adrenalectomy: An Anatomical Essay and Surgical Update

by Bogdan Ovidiu Feciche, Vlad Barbos, Alexandru Big, Daniel Porav-Hodade, Alin Adrian Cumpanas, Silviu Constantin Latcu, Flavia Zara, Alina Cristina Barb, Cristina-Stefania Dumitru, Talida Georgiana Cut, Hossam Ismail and Dorin Novacescu

Cancers 2024, 16(22), 3841; https://doi.org/10.3390/cancers16223841 - 15 Nov 2024

Cited by 1 | Viewed by 1571

Abstract

Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and [...] Read more.

Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique “backdoor” approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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Other

Jump to: Research, Review

12 pages, 2926 KiB

Open AccessSystematic Review

Adrenalectomy Performed with the Da Vinci Single-Port Robotic System: A Systematic Review and Pooled Analysis

by Giuseppe Reitano, Arianna Tumminello, Carlo Prevato, Anna Cacco, Greta Gaggiato, Giorgia Baù, Lorenzo Sabato, Elisa Tonet, Anna Gambarotto, Valerio Fusca, Kevin Martina, Silvia Visentin, Giovanni Betto, Giacomo Novara, Fabrizio Dal Moro and Fabio Zattoni

Cancers 2025, 17(8), 1372; https://doi.org/10.3390/cancers17081372 - 20 Apr 2025

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Abstract

Introduction: The Da Vinci Single-Port (DV-SP) system emerged in 2018 but there is limited evidence on its use and perioperative outcomes for robot-assisted adrenalectomy (RAA). Methods: A systematic search was performed through PubMed, Scopus, Ovid, and WoS in December 2024. A PICO framework [...] Read more.

Introduction: The Da Vinci Single-Port (DV-SP) system emerged in 2018 but there is limited evidence on its use and perioperative outcomes for robot-assisted adrenalectomy (RAA). Methods: A systematic search was performed through PubMed, Scopus, Ovid, and WoS in December 2024. A PICO framework was used. Population: adult patients with adrenal masses; Intervention: DV-SP RAA; Outcomes: feasibility, reproducibility and safety of DV-SP RAA. A total of five retrospective studies involving 342 patients were included. The quantitative analysis was conducted using a random-effect model or a fixed-effect model as appropriate. A risk of bias assessment for non-randomized comparative studies and case series was performed. Results: The pooled mean operative time was 92.5 min (95% confidence interval [CI] 71.2, 113.9, p I² = 0%, four studies), and the mean estimated blood loss (EBL) was 26.5 mL (95%CI −8.1, 61.2, I² = 98.2%, three studies). Most of the procedures were completed with a single incision, though some required additional port placement, with a proportion of 9% (95%CI 0, 29, I² = 71.7%, five studies). Perioperative complications were rare (0%, 95% CI 0, 4, I² = 0%, five studies). Two studies comparing DV-SP and DV multi-port (MP) found no significant differences in complications. One study compared DV-SP RAA to DV Si or Xi single-access procedures. DV-SP showed improved operative techniques and better cosmetic outcomes. Limitations of this study are small sample size and potential selection bias due to smaller masses in the DV-SP RAA group. Conclusions: DV-SP RAA is a promising approach, offering reduced operative time, low EBL, and excellent cosmetic results. This study shows that DV-SP RAA seems reproducible, feasible, and safe. Limitation of the included studies are small sample size and selection bias, which limits the generalizability of the results. Randomized comparative studies between DV-SP and MP RAA are needed to further validate these findings. Full article

(This article belongs to the Special Issue Urologic Cancer: Endoscopic, Laparoscopic, and Robot-Assisted Surgery Management)

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