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Robotic Urological Surgery: Clinical Updates for Better Outcomes

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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 (30 August 2025) | Viewed by 6829

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Special Issue Editor

Prof. Dr. Shigeo Horie

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Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
Interests: prostate cancer; robotic surgery; genetics; digital therapeutics; testosterone
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Special Issue Information

Dear Colleagues,

This Special Issue aims to gather cutting-edge research and clinical experiences that highlight the advancements and benefits of robotic surgery in urology. We invite investigators and surgeons from academic institutions and clinical hospitals to contribute high-quality articles that will advance the field and improve patient care.

The scope of the Special Issue encompasses the following:

Technological Advances: Articles exploring the latest innovations in robotic systems and their applications in urological surgery.
Clinical Outcomes: Research studies and clinical trials assessing the efficacy, safety, and long-term outcomes of robotic urological procedures.
Surgical Techniques: Detailed descriptions and evaluations of novel surgical techniques and approaches in robotic urology.
Surgical Simulation and Navigation: Studies and reviews on the use of surgical simulation and navigation systems to enhance the precision and effectiveness of robotic urological procedures.
Patient Perspectives: Studies focusing on patient-reported outcomes, satisfaction and quality of life following robotic urological surgery.
Future Directions: Visionary articles and reviews predicting the future trends and potential developments in robotic urological surgery.

This Special Issue will serve as a comprehensive resource for clinicians and researchers, aiming to improve surgical outcomes and patient care in urology through the use of robotic technology. We encourage submissions that provide robust evidence, innovative perspectives and practical insights into the field of robotic urological surgery.

Prof. Dr. Shigeo Horie
Guest Editor

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 250 words) can be sent to the Editorial Office for assessment.

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.

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Keywords

robotic urological surgery
clinical outcomes
surgical techniques
surgical navigation
patient-reported outcomes
side effects
incident

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Published Papers (4 papers)

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Research

17 pages, 1698 KB

Open AccessArticle

Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series

by Chin-Heng Lu, Min-Che Tung, Chu-Shan Yuan, Yi-Sheng Lin, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Hsu, Tang-Yi Tsao, Yen-Chuan Ou and Chia-Che Chang

J. Clin. Med. 2025, 14(24), 8759; https://doi.org/10.3390/jcm14248759 - 10 Dec 2025

Viewed by 592

Abstract

Background/Objectives: Functional continence and potency outcomes are paramount for the pentafecta of robotic-assisted laparoscopic radical prostatectomy (RARP). We describe a modified approach of the pubovesical complex (PVC)-sparing technique under hypothermia for better continence and potency preservation. Methods: This is a retrospective single-institution case series. Thirty-three PVC-sparing RARP procedures under hypothermia were performed in patients with clinically localized prostate cancer by the same experienced surgeon. The method includes four principles: (1) modified PVC-sparing technique, according to Richard Gaston et al., (2) the use of near-infrared fluorescence technology and indocyanine green to identify the benchmark artery of the neurovascular bundle and blood supply for the PVC, (3) accessory pudendal artery preservation, and (4) hypothermia to reduce tissue edema. Functional outcomes, including continence, potency, and other surgical findings, are presented. This is a feasibility case series, not a comparative or hypothesis-testing study. Results: This study enrolled 33 cases from 15 April 2020 to 31 December 2022. Four patients had positive surgical margins. The urinary continence rate was 100% after Foley removal at a mean of 6.6 days. The potency rate was 74% (17/23) at 6 months and 91.3% (21/23) at 12 months. The inclusion of a small sample of patients from a single hospital and the selection of patient conditions were the study limitations. Conclusions: The modified approach we described is technically feasible, and it can expedite the restoration of urinary function and potency preservation. No severe complications occurred, and patients achieved good oncological outcomes. Full article

(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)

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13 pages, 1240 KB

Open AccessArticle

Renal Functional Outcomes in Robot-Assisted Partial Nephrectomy with Minimum Layer Resection Using Virtual Three-Dimensional Image Assistance

by Shuji Isotani, Tomoki Kimura, Taiki Ogasa, Takuro Kobayashi, Ippei Hiramatsu, Takeshi Ieda, Toshiyuki China, Fumitaka Shimizu, Masayoshi Nagata, Yuki Nakagawa, Hisamitsu Ide and Shigeo Horie

J. Clin. Med. 2025, 14(20), 7133; https://doi.org/10.3390/jcm14207133 - 10 Oct 2025

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Abstract

Background: Robot-assisted partial nephrectomy (RAPN) is a standard approach for localized renal cell carcinoma (RCC), emphasizing renal functional preservation. The Minimum Layer Resection (MLR) method, guided by 3D virtual partial nephrectomy (3DvPN) planning, was developed to balance oncological safety with parenchymal preservation. This study evaluated functional and oncological outcomes of RAPN with MLR and identified predictors of renal functional decline. Methods: We retrospectively analyzed 237 patients (after screening 312 cases) who underwent RAPN between 2012 and 2022 with ≥36-month follow-up. 3DvPN planning was used to guide MLR when feasible; both MLR and non-MLR were available and applied throughout the study period according to predefined indications. The primary endpoint was the percentage of estimated glomerular filtration rate (eGFR) preservation at 36 months; a ≥10% decline was clinically significant. Secondary endpoints included perioperative outcomes, acute kidney injury (AKI), and oncological outcomes such as margin involvement and recurrence. Results: The median age was 60 years, tumor size 29 mm, and warm ischemia time 21 min, with selective or superselective clamping achieved in 62.8% of cases. Postoperative AKI occurred in 25.0% (no patient required dialysis). At 3 years, the median eGFR preservation rate was 84.4%, and 28.5% of patients experienced a ≥10% decline. Independent predictors of short-term decline (14 days) were BMI > 25 kg/m², AKI, and WIT > 25 min, whereas long-term decline (36 months) was associated with tumor size > 30 mm and WIT > 25 min. Margin involvement was 1.7%, recurrence 3.8%, and major complications (Clavien–Dindo ≥IV) occurred in 1.7%. Conclusions: In conclusion, RAPN with the MLR technique under 3DvPN guidance demonstrated favorable perioperative outcomes, acceptable oncologic safety, and good mid-term renal functional preservation (up to 36 months). The approach provides a reproducible surgical strategy that maximizes parenchymal preservation while maintaining negative surgical margins. Prospective multicenter studies with longer follow-up are warranted to confirm long-term durability and to define the role of MLR in routine practice. Full article

(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)

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10 pages, 825 KB

Open AccessArticle

Comparison of Perioperative Outcomes for Complex Renal Tumors Between the Da Vinci and Hinotori Surgical Robot System During Robot-Assisted Partial Nephrectomy: A Propensity Score Matching Analysis

by Daisuke Motoyama, Kyohei Watanabe, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Hideaki Miyake and Teruo Inamoto

J. Clin. Med. 2025, 14(16), 5850; https://doi.org/10.3390/jcm14165850 - 19 Aug 2025

Cited by 1 | Viewed by 2097

Abstract

Background/Objectives: This study aimed to evaluate and compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for complex renal tumors performed using the novel Japanese Hinotori Surgical Robot System (HSRS) and the established Da Vinci Surgical System (DVSS). Methods: Of 484 consecutive patients who underwent RAPN at our institution, 126 with complex renal tumors were included in the DVSS group, and 48 such patients were included in the HSRS group. Complex tumors in this series were defined by the presence of at least one of the following factors: cT1b, completely endophytic, hilar, cystic, or ipsilateral multiple tumors. Results: Following 1:2 propensity score matching, 74 and 37 patients were included in the DVSS and HSRS groups, respectively. Post-matching, most covariates’ absolute standardized mean difference (SMD) was less than 0.1, indicating effective baseline imbalance correction. All RAPN procedures using HSRS were completed without conversion to open surgery, nephrectomy, or Clavien–Dindo ≥3 postoperative complications. No significant differences in major perioperative outcomes were observed between DVSS and HSRS, including operative time (178 vs. 186 min), console time (115 vs. 115 min; encompassing cockpit time for HSRS), warm ischemia time (15 vs. 15 min), and estimated blood loss (51 vs. 30 mL). Positive surgical margin rates (DVSS 1.4% vs. HSRS 5.4%) and Trifecta achievement rates (94.6% vs. 91.9%) were also comparable, with no significant differences. Conclusions: These findings suggest that, even in patients with complex renal tumors, RAPN performed using the HSRS can achieve perioperative outcomes comparable to those obtained with the established DVSS. Full article

(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)

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10 pages, 688 KB

Open AccessArticle

Impact of the Enhanced Recovery After Surgery Protocol on the Perioperative Outcomes of Robot-Assisted Radical Cystectomy

by Kosuke Kitamura, Yuto Miyoshi, Takeshi Ieda, Toshiyuki China, Fumitaka Shimizu, Shigeo Horie and Satoru Muto

J. Clin. Med. 2025, 14(9), 3082; https://doi.org/10.3390/jcm14093082 - 29 Apr 2025

Viewed by 2188

Abstract

Objectives: The enhanced recovery after surgery (ERAS) protocol is a coordinated approach aimed at providing the best evidence-based perioperative care. This study examined whether combining robot-assisted radical cystectomy (RARC) with the ERAS protocol could reduce postoperative complications and hospital length of stay (LOS). We also assessed the impact of high and low adherence to the ERAS protocol on oncological outcomes. Methods: Eighty patients who underwent RARC with urinary diversion at Juntendo University Hospital and Juntendo University Nerima Hospital between April 2014 and December 2021 were included. The ERAS protocol consisted of 15 items, and the achievement rate for each item was assessed. We evaluated the effects of adherence on complications and hospital LOS, as well as the relationship between ERAS implementation and postoperative oncological prognoses. Results: Patients were divided into high-adherence (n = 39) and low-adherence (n = 41) groups based on adherence to 12 or more ERAS items. Patient demographics, including age, sex, and clinical stage, were statistically similar. The high-adherence group had a significantly shorter postoperative hospital LOS (19 days vs. 24 days; p = 0.013) and fewer complications (p = 0.015) compared to the low-adherence group. Furthermore, the high-adherence group exhibited a significantly improved overall survival rate (p = 0.029), while no significant difference was found in progression-free survival (p = 0.125). Conclusions: Integrating the ERAS protocol with RARC can reduce postoperative complications and hospital LOS. High adherence to the ERAS protocol is associated with improved prognoses and outcomes compared to low adherence. Full article

(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)

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