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Robotic Urologic Surgery: Clinical Applications and Advances

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Prof. Dr. Athanasios N. Kostakopoulos

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1st Department of Urology, Metropolitan General Athens, 15562 Athens, Greece
Interests: urologic surgery; robotic-assisted urologic surgery; minimally invasive urologic surgery; urologic oncology
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Dr. Nikolaos Kostakopoulos

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1st Department of Urology, Metropolitan General Athens, 15562 Athens, Greece
Interests: urological cancers; prostate cancer; urothelial cancer; kidney cancer; advances in diagnosis; advances in treatment

Special Issue Information

Dear Colleagues,

The evolution of robotic surgery in urology during the last years is immensive. Several new robotic platforms have been introduced for the treatment of urological malignancies and the use of artificial intelligence and telesurgery have greatly improved accessibility and success of robotic procedures around the world. Furthermore, 3d models have facilitated safer preoperative design of robotic procedures such as robotic partial nephrectomy and robotic radical prostatectomy, while development of more surgeon-friendly consoles, have better accommodated robotic surgeons during long oncological cases. In this Special Issue, we welcome authors to submit papers on the clinical applications and advances in robotic urologic surgery for the treatment of benign and malignant urologic diseases.

Prof. Dr. Athanasios N. Kostakopoulos
Guest Editor

Dr. Nikolaos Kostakopoulos
Guest Editor Assistant

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9 pages, 613 KB

Open AccessArticle

Combined Robot-Assisted Radical Cystectomy and Robot-Assisted Nephroureterectomy for Synchronous High-Risk Upper Urinary Tract and Bladder Cancer: A Single-Center Retrospective Study and Review of the Literature

by Nikolaos Kostakopoulos, Konstantinos Evmorfopoulos, Gianluca Maresca, Grigorios Athanasiadis, Athanasios Kostakopoulos and Konstantinos Dimitropoulos

J. Clin. Med. 2026, 15(9), 3411; https://doi.org/10.3390/jcm15093411 - 29 Apr 2026

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Abstract

Background/Objectives: Simultaneous robotic-assisted radical cystectomy (RARC) and nephroureterectomy (RARNU) offers a minimally invasive alternative to open approach for patients with synchronous bladder and upper urinary tract cancers, as well as in selected benign conditions. This study presents our single-center experience and also includes a review of the relevant literature. Methods: All patients undergoing combined RARC and RARNU between 2016 and 2023 were retrospectively identified. Clinical and demographic data—including preoperative pathology, operative and re-docking times, estimated blood loss, complications (Clavien–Dindo system), surgical margins, recurrence, morbidity, and follow-up—were collected. A rapid review of the literature was also conducted. Results: From 2016 to 2023, 10 patients (mean age 67.4 years, range 56–77) underwent combined RARC and RARNU for upper/lower tract urothelial malignancy. Mean re-docking time was 68.2 min (range 51–100), mean operative time 524.5 min (range 380–690), and mean blood loss 427 cc (range 75–1170). A Pfannenstiel incision was used for en bloc specimen extraction, with no complications or incisional hernias. One case was converted to open surgery, and two required extracorporeal diversion. Postoperatively, five Grade 2 complications were reported, along with one Grade 3, and one Grade 5. All surgical margins were negative. Mean hospital stay was 11.5 days (range 5–29). At a mean follow-up of 21.7 months, one patient had become dialysis-dependent and one had experienced recurrence requiring further surgery. The review of the literature included 74 patients with comparable outcomes. Conclusions: Combined RARC and RARNU is a feasible, minimally invasive option for selected patients. Although technically demanding, it offers acceptable safety and should be performed in high-volume, specialized centers. Full article

(This article belongs to the Special Issue Robotic Urologic Surgery: Clinical Applications and Advances)

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14 pages, 715 KB

Open AccessArticle

The Nerve-Sparing Quality (NSQ) Score: A Novel Intraoperative Scoring System for Assessing Nerve-Sparing Quality During Robot-Assisted Radical Prostatectomy—A Concept and Feasibility Study

by Jakub Kempisty, Krzysztof Balawender, Oskar Dąbrowski and Karol Burdziak

J. Clin. Med. 2026, 15(8), 2979; https://doi.org/10.3390/jcm15082979 - 14 Apr 2026

Viewed by 389

Abstract

Introduction: Nerve-sparing (NS) during robot-assisted radical prostatectomy (RARP) plays a critical role in postoperative functional recovery, particularly urinary continence and erectile function. Despite the importance of precise neurovascular bundle (NVB) preservation, intraoperative assessment of NS quality remains largely subjective and lacks standardized evaluation tools. The aim of this study was to develop and preliminarily evaluate a structured intraoperative scoring system designed specifically for assessing NS quality during RARP. Methods: A novel 10-point intraoperative NS scoring system (NSQ Score) based on five domains was developed: dissection plane, bleeding control, bundle manipulation, continuity of dissection, and symmetry. Each parameter was rated on a 0–2 scale. Thirty robot-assisted radical prostatectomy (RARP) procedures performed in 2024 were randomly selected from a prospectively maintained institutional surgical video archive. Cases were not pre-filtered based on tumor stage, surgical difficulty, or intraoperative complexity. High-definition video recordings of the nerve-sparing phase were anonymized and independently evaluated by three experienced observers blinded to patient outcomes and to each other’s assessments. Inter-rater agreement was analyzed using weighted Cohen’s kappa statistics with quadratic weights, complemented by exact and near-agreement proportions. Cluster bootstrap resampling was applied to account for bilateral observations. Results: A total of 48 evaluable observations were analyzed. The overall inter-rater agreement demonstrated a weighted kappa of 0.41 (95% CI 0.36–0.48), indicating fair-to-moderate agreement among reviewers. Exact agreement occurred in 43% of observations, while near-agreement (allowing one ordinal level difference) reached 98%. Among individual parameters, symmetry demonstrated the highest reliability with substantial agreement (κ = 0.70; 95% CI 0.58–0.81). Other domains showed fair agreement, including intraoperative bleeding (κ = 0.36), continuity of dissection (κ = 0.39), bundle manipulation (κ = 0.34), and dissection plane (κ = 0.27). Agreement levels were comparable between left- and right-sided dissections. Conclusions: We propose a novel structured intraoperative scoring system for evaluating nerve-sparing quality during RARP. The scale is simple, procedure-specific, and feasible for structured postoperative or video-based assessment. Preliminary results demonstrate fair-to-moderate inter-rater reliability with very high near-agreement, supporting the feasibility of this tool for clinical use. The proposed scoring system may facilitate standardized training, objective performance assessment, and future studies correlating intraoperative NS quality with functional outcomes. Full article

(This article belongs to the Special Issue Robotic Urologic Surgery: Clinical Applications and Advances)

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