Search Results (105)

Background and Objective: Adverse pathology to high-risk prostate cancer (PCa) after radical prostatectomy (upgrading) poses a threat to risk stratification and treatment planning. The impact on sexual function, urinary continence, and health-related quality of life (HRQOL) remains unclear. Methods: From 2004 to 2024, 4189 patients with preop low-/intermediate-risk PCa (Gleason score 6 or 7a, PSA ≤ 20 ng/mL) underwent radical prostatectomy at our department and were analyzed. Primary endpoint was HRQOL, erectile function, and urinary continence. Secondary endpoint was rate of salvage therapies and biochemical-free survival. Propensity score matching was performed using “operative time”, “robot-assisted surgery”, “blood loss”, “nerve-sparing surgery”, “age”, and “BMI” to represent comparable surgical approach. Median follow-up was 39 months (Interquartile-range (IQR) 15–60). Key Findings and Limitations: Patients who were upgraded to high-risk PCa showed a higher rate of postoperative radiotherapy and androgen-deprivation therapy compared to patients who were not upgraded (21% vs. 7%, p < 0.001; 9% vs. 3%, p = 0.002). Five-year biochemical recurrence-free survival was 68% in the upgrading group vs. 84% in the no-upgrading group (p < 0.001). We saw no difference in patient-reported HRQOL, urinary continence, or erectile function. Multivariable analysis showed that postoperative upgrading was a significant risk for not achieving good overall HRQOL (OR: 0.77, 95% CI: 0.61–0.97, p = 0.028) during the follow-up. Conclusions and Clinical Implications: Although postoperative upgrading to high-risk PCa leads to worse oncologic outcomes and higher salvage therapy rates, this study indicates that its impact on health-related quality of life is minimal and should not deter a cautious approach to radical prostatectomy. Full article

Lung cancer remains one of the main causes of cancer-related death globally and a significant global health concern. There is an urgent need for safer and more effective therapeutic alternatives despite notable progress in therapy; issues such as drug resistance, side effects, metastasis, and recurrence still affect patient outcome and quality of life. The aim of this review is to examine recent developments in the application of herbal-drug-loaded nanoparticles as a new strategy for treating lung cancer. A thorough examination of different drug delivery systems based on nanoparticles is provided, highlighting their function in improving the solubility, bioavailability, and targeted delivery of herbal compounds. In addition, the review evaluates the biomarkers used for targeted therapy and examines how new personalised treatment approaches like wearable electronic patches, robotics-assisted interventions, smartphone-enabled therapies, AI-driven diagnostics, and lung-on-a-chip technologies can be integrated to improve the accuracy and effectiveness of lung cancer treatment. In conclusion, the combination of personalised medicine and nanotechnology may lead to revolutionary changes in lung cancer treatment in the future. Full article

Background/Objectives: Prostate cancer ranks as the second-most prevalent cancer globally, and is the fifth-ranking cause of cancer-related mortality. Radical prostatectomy presents a significant risk of postoperative sequelae, including erectile dysfunction. Postoperative erectile dysfunction adversely affects the patient’s quality of life and can severely impact total treatment satisfaction. Nomograms have demonstrated efficacy in forecasting diverse outcomes in urology. We sought to create a nomogram to facilitate a more precise, evidence-based, and individualized prediction of erectile function outcomes following radical prostatectomy. Between January 2018 and January 2022, one hundred and eleven prostate cancer patients had robot-assisted radical prostatectomy, excluding those who had undergone prior transurethral prostatectomy, radiotherapy, or hormone therapy. Demographics, medical records, preoperative and postoperative erectile function statuses, and IIEF scores (≥17 indicating retained erections, <17 indicating full erectile dysfunction) were evaluated. Outcomes: Patients’ ages ranged from 45 to 76 years, with an average of 61.18 ± 6.72 years. Patients in the emergency department were considerably older (p = 0.004; p < 0.01) and exhibited elevated Charlson Comorbidity Indices (3.63 ± 0.85; p = 0.004; p < 0.01). Preoperative IIEF scores in ED patients were lower (14.29 ± 5.34), although obturator internus thickness (20.61 ± 2.91) and intraprostatic urethra length (36.48 ± 9.3) were considerably elevated. Altered surgical techniques were linked to maintained erections (p = 0.002; p < 0.01), but traditional approaches were connected with erectile dysfunction (p = 0.007; p < 0.01). Bilateral nerve-sparing procedures were more prevalent among patients preserving erectile function (p = 0.003; p < 0.01). Conclusions: The nomogram, which includes age, Charlson Comorbidity Index, preoperative IIEF, obturator internus thickness, intraprostatic urethra length, surgical technique, and degree of nerve preservation, provides clinicians with a pragmatic instrument for forecasting postoperative erectile dysfunction in prostate cancer patients. Full article

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management. Full article

(1) Background: Lymphedema is a common but underrecognized sequela of cancer treatment. Supermicrosurgical procedures such as lymphaticovenular anastomosis (LVA) and, more recently, lymph node-to-vein anastomosis (LNVA) have emerged as effective options for fluid-predominant disease. In 2024, we began performing robot-assisted LNVA using a next-generation microsurgical robot. This study describes our initial experience, technical insights, and the potential for robotics to extend the boundaries of supermicrosurgery. (2) Methods: Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon at a tertiary center. Preoperative imaging with standard and ultra-high frequency ultrasound was used to identify optimal lymph nodes and veins. Robotic LNVA was performed using the Symani Surgical System, with adaptations for motion scaling, ergonomics, and console control. Intraoperative patency was confirmed by direct washout and/or indocyanine green (ICG) transit. (3) Results: All 22 procedures were technically successful, with 100% intraoperative patency. Anastomosis time improved from 37 to 18 min. Robotic assistance enhanced precision, eliminated tremors, and reduced the technical burden of operating at extreme submillimeter scales. (4) Conclusions: Robotic LNVA is safe, feasible, and efficient. It optimizes current techniques, offering the potential to extend surgical access below the 0.1 mm threshold, with implications for future treatment of lymphatic and possibly intracranial disease. Full article

Background/Objectives: Prostate cancer is the second most common malignancy in men, and robot-assisted radical prostatectomy (RARP) has become a preferred treatment for localized disease. Postoperative urinary continence is a key determinant of quality of life. The aim of this study was to evaluate the preoperative patient characteristics and multiparametric magnetic resonance imaging (mpMRI) data that determine early postoperative continence in patients who underwent robotic radical prostatectomy at our clinic. Methods: In this study, patients who underwent robotic radical prostatectomy at our clinic between March 2020 and June 2022 were evaluated. The patients’ demographic data, preoperative PSA levels, digital rectal examination findings, preoperative lower urinary tract symptoms, sexual function, mpMRI findings, Briganti scores, surgical techniques used during the procedure and postoperative continence status were assessed. Results: A total of 111 patients were included in the study. The mean age of the patients was 61.1 years. The median follow-up duration was twelve months. According to the postoperative continence status, 22% of the patients were incontinent, 53% had moderate continence and 24% were fully continent in the first month. At the third month, 16.8% of the patients were incontinent, 31.3% had moderate continence and 51.8% were fully continent. At the one-year postoperative follow-up, the percentages of incontinent, moderately continent and fully continent patients were 4.8%, 13.2% and 81.9%, respectively. Urethral width in mpMRI (p: 0.012), pelvic transverse (p: 0.002) and AP (anterior–posterior) diameters (p: 0.033), preoperative IPSS scores (p: 0.033) and the presence of bilateral nerve-sparing surgery (p: 0.047) were found to be associated with postoperative urinary continence. No significant differences were found between groups regarding the relationship of other parameters evaluated by mpMRI with continence. Conclusions: In our study, preoperative IPSS scores, urethral width in mpMRI, pelvic transverse and AP diameters and the performance of nerve-sparing surgery were associated with early postoperative continence. Further studies with larger patient populations are needed to better understand the long-term predictors of postoperative urinary incontinence following radical prostatectomy. Full article

Robot-assisted surgery has proven highly effective in the curative treatment of various gastrointestinal cancers. The advantages of robot-assisted surgery, including precision, enhanced operability, and magnified 3D visualization, allow surgeons to perform delicate procedures that would be challenging with conventional laparotomy or laparoscopy. These benefits make robot-assisted surgery a viable modality for treating various malignant tumors and an essential tool in curative surgery for solid cancers. Laparoscopic gastrectomy is currently the standard treatment for early gastric cancer, with numerous clinical trials assessing the efficacy of robot-assisted surgery. Although thoracoscopic esophagectomy has demonstrated advantages over open surgery in radical esophageal cancer treatment, ongoing studies are evaluating the noninferiority and potential benefits of robotic surgery. Robot-assisted surgery is also being explored for conversion surgery in cases where radical resection becomes feasible after multidisciplinary treatment and in polysurgery cases involving multiple prior laparotomies. However, establishing robust evidence for its efficacy in radical surgery for conversion and polysurgery cases remains a challenge. This narrative review discusses the advantages and limitations of robot-assisted surgery in such complex cases based on an analysis of the literature. Additionally, it examines the prospects of robotic-assisted surgery in polysurgery, metachronous remnant gastric cancer, and conversion surgery. Full article

Prostate cancer remains a major global health challenge, ranking as the second most common malignancy in men worldwide. Advances in diagnostic and therapeutic strategies have transformed its management, enhancing patient outcomes and quality of life. This review highlights recent breakthroughs in imaging, including multiparametric MRI and PSMA-PET, which have improved cancer detection and staging. Biomarker-based diagnostics, such as PHI and 4K Score, offer precise risk stratification, reducing unnecessary biopsies. Innovations in treatment, including robotic-assisted surgery, novel hormone therapies, immunotherapy, and PARP inhibitors, are redefining care for localized and advanced prostate cancer. Artificial intelligence (AI) and machine learning (ML) are emerging as powerful tools to optimize diagnostics, risk prediction, and treatment personalization. Additionally, advances in radiation therapy, such as IMRT and SBRT, provide targeted and effective options for high-risk patients. While these innovations have significantly improved survival and minimized overtreatment, challenges remain in optimizing therapy sequencing and addressing disparities in care. The integration of AI, theranostics, and gene-editing technologies holds immense promise for the future of prostate cancer management. Full article

Despite advancements in multidisciplinary treatment, esophagectomy remains the primary curative treatment for esophageal cancer. Given that lymph node metastases can spread from the cervical to abdominal regions, three-field lymph node dissection has been established as a standard approach. However, this highly invasive procedure involves multiple anatomical regions—thoracic, abdominal, and cervical—leading to significant surgical burden. To reduce surgical invasiveness, minimally invasive esophagectomy (MIE) has become increasingly common worldwide. With its adoption and advancements in multidisciplinary therapy, discussions have emerged regarding the potential omission of lymph node dissection in selected cases. Since the introduction of robot-assisted minimally invasive esophagectomy (RAMIE) in 2004, this technique has progressively replaced conventional MIE. Robotic systems—equipped with a magnified 3D camera, articulated instruments, and tremor filtering—allow surgeons to perform complex procedures with greater precision than manual techniques. One randomized controlled trial (RCT) has demonstrated fewer postoperative complications with RAMIE compared to open esophagectomy. Additionally, RAMIE has been shown to enable more extensive lymph node dissection around the left recurrent laryngeal nerve than conventional MIE. However, the long-term oncological benefits of RAMIE remain unproven, as no RCTs have definitely confirmed its impact on long-term survival in esophageal cancer patients. Ongoing randomized trials are expected to provide further insights into its prognostic benefits. Full article

Robot-assisted surgery has transformed the landscape of genitourinary cancer treatment, offering enhanced precision, reduced morbidity, and improved recovery compared to open or conventional laparoscopic approaches. As the field matures, a new generation of technological innovations is redefining the boundaries of what robotic systems can achieve. This narrative review explores the integration of artificial intelligence, advanced imaging modalities, augmented reality, and connectivity in robotic urologic oncology. The applications of machine learning in surgical skill evaluation and postoperative outcome predictions are discussed, along with AI-enhanced haptic feedback systems that compensate for the lack of tactile sensation. The role of 3D virtual modeling, intraoperative augmented reality, and fluorescence-guided surgery in improving surgical planning and precision is examined for both kidney and prostate procedures. Emerging tools for real-time tissue recognition, including confocal microscopy and Raman spectroscopy, are evaluated for their potential to optimize margin assessment. This review also addresses the shift toward single-port systems and the rise of telesurgery enabled by 5G connectivity, highlighting global efforts to expand expert surgical care across geographic barriers. Collectively, these innovations represent a paradigm shift in robot-assisted urologic oncology, with the potential to enhance functional outcomes, surgical safety, and access to high-quality care. Full article

Background/Objectives: Radical prostatectomy is a standard treatment for localized prostate cancer. We aimed to compare perioperative outcomes and functional results between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP). Methods: A retrospective analysis was conducted on 120 patients who underwent LRP (n = 60) or RARP (n = 60). Perioperative parameters, including operative time, hospitalization duration, blood transfusion rate, wound healing complications, urinary catheterization duration, urinary tract infections (UTIs), and urinary incontinence, were assessed. Statistical analyses included Student’s t-, Mann–Whitney U, and χ² tests. Results: RARP was associated with significantly shorter operative time, compared with LRP (147.25 vs. 188.30 min, p < 0.0001). No significant differences were observed in hospitalization duration, transfusion rates, or overall complication rates. However, impaired wound healing was less frequent in the RARP group, with a 10% lower incidence, compared with the LRP group (p = 0.0946). Similarly, UTIs occurred less often in the RARP group (six vs. one cases; p = 0.0544). Urinary incontinence was significantly less frequent following RARP, with its incidence being more than twice as low, compared with the LRP group (p = 0.0032). Additionally, the RARP group had significantly lower International Prostate Symptom Scores, with a mean difference of 7.83 points, indicating improved urinary function. No significant differences were found in sexual function (IIEF-5 scores). Conclusions: RARP offers advantages over LRP, including reduced operative time, lower rates of wound healing complications, decreased incidence of urinary incontinence, and improved postoperative urinary function. Further studies with larger cohorts are warranted to confirm these findings and assess long-term functional and oncological outcomes. Full article

Background: Robot-assisted radical prostatectomy (RARP) is a common treatment option for prostate cancer. A 3D model for surgical guidance can improve surgical outcomes. Manual expert radiologist segmentation of the prostate and tumor in prostate MRI to create 3D models is labor-intensive and prone to inter-observer variability, highlighting the need for automated segmentation methods. Methods: This study evaluates the performance of the prostate and tumor segmentation using a commercially available AI tool without (fully automated) and with manual adjustment (AI-assisted) compared to manual segmentations on 120 patients, using several metrics, including Dice Coefficient and Hausdorff distance. Tumor detection rates were assessed with recall and precision. Results: For the prostate, both the fully automated AI model and AI-assisted model achieved a mean Dice score of 0.88, while AI-assisted had a lower Hausdorff distance (7.22 mm) compared to the fully automated (7.40 mm). For tumor segmentations, the Dice scores were 0.53 and 0.62, with Hausdorff distances of 9.53 mm and 6.62 mm obtained for fully automated AI and AI-assisted methods, respectively. The fully automated AI method had a recall of 0.74 and a precision of 0.76 in tumor detection, while the AI-assisted method achieved 0.95 recall and 0.94 precision. Fully automated segmentation required less than 1 min, while adjustments for the AI-assisted segmentation took an additional 81 s, and manual segmentation took approximately 15–30 min. Conclusions: The fully automated AI model shows promising results, offering high tumor detection rates and acceptable segmentation metrics. The AI-assisted strategy improved the relevant metrics with minimal additional time investment. Therefore, the AI-assisted segmentation method is promising for allowing 3D-model-guided surgery for all patients undergoing RARP. Full article

Lung cancer is the leading cause of cancer-related mortality among both men and women worldwide, underscoring the need for an effective treatment strategy. For early-stage non-small cell lung cancer [NSCLC], surgical resection is the standard treatment. Robotic-assisted thoracic surgery [RATS] and video-assisted thoracic surgery [VATS] are better than open thoracotomy because they are less invasive. Recent lung cancer screening programs are detecting NSCLC at earlier stages, which is expected to result in an increase in the number of NSCLC surgeries as early-stage cases are diagnosed. A limited number of randomized controlled trials have compared RATS and VATS in operable NSCLC. We conducted a literature review to summarize the available evidence on these two surgical techniques. The purpose of this study is to compare the intraoperative and postoperative outcomes of RATS and VATS in early-stage NSCLC patients. RATS shows lower conversion rates to thoracotomy (6.3% vs. 13.1% p < 0.01) and more thorough lymph node dissection than VATS (e.g., 7.5 vs. 5.6 stations, p < 0.001). However, RATS is linked to considerably higher costs (USD 22,582 vs. USD 17,874, p < 0.05) and longer operative times (median 241.7 vs. 214.4 min, p = 0.06). The two techniques exhibited minimal differences in postoperative complications and pain, while RATS patients experienced shortened hospital stays (4–5 vs. 5–6 days, p < 0.006). While the accuracy of staging and treatment planning is improved by the improved lymph node retrieval in RATS, the long-term survival rate is still uncertain. Full article

Introduction: Radical cystectomy (RC) is the gold standard for urothelial cT2-4a, N0, M0 muscle-invasive bladder cancer (MIBC). However, bladder-sparing strategies (BSS) such as Trimodality Therapy (TMT) have emerged as alternative treatments for a select group of localized muscle-confined (cT2) urothelial bladder cancers. Accordingly, reliable preoperative staging and a reliable risk factor assessment linked to pathological upstaging play a key role in adequate counselling and patient selection for BSS. Patients and Methods: cT2 MIBC patients undergoing RC at our institution from 2014 to 2024 were reviewed. Preoperative staging modalities, demographics, and tumour and patient characteristics were assessed. Multivariable logistic regression was applied to explore the relative effect of confounders on any pathological upstaging from robot-assisted or open RC specimens. Subgroup analysis according to the local upstaging (>pT2) or nodal dissemination (pN+) was also performed. Results: N = 275 RCs were included (73.5% males, 26.5% females). Upstaging was documented in n = 141 (51%) cases. Of these, n = 125 (45.5%) were upstaged locally (>pT2) and n = 35 (23%) yielded pN+ disease. Preoperative parameters like gender, the number of TURBTs, previous BCG exposure, and concomitant CIS did not significantly influence the risk of any kind of upstaging (p > 0.05). At multivariable analysis, neoadjuvant chemotherapy (NAC) and multi-disciplinary team (MDT) discussion were found protective (odds ratio [OR]: 0.4, 95%CI 0.2–0.7, p = 0.001 and OR: 0.51, 95%CI 0.2–0.9, p = 0.01). Preoperative FDG-PET assessment yielded higher risk for later pN upstaging (OR: 1.8, 95%CI 1–3, p = 0.05). HG/G3 features at TURBT along with mixed/pure histology variants in RC specimens were the most relevant independent predictors for both any and pT upstaging (OR: 4.3, 95%CI 1–34, p = 0.04 and OR: 2.3, 95%CI 1.1–4.6, p = 0.02 for any upstaging and OR: 5.6, 95%CI 1.3–36, p = 0.02 and OR: 2.5, 95%CI 1.3–5, p = 0.01 for pT upstaging, respectively). Conclusions: In this study, over half of the patients undergoing RC for cT2 were upstaged at the final pathology. Therefore, adequate counselling and examining the non-conventional criteria for prognosis is mandatory in the contemporary era of bladder-preservation strategies. Full article

Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection. Several studies demonstrated its feasibility and safety, with promising accuracy in nodal staging during robot-assisted radical prostatectomy (RARP) and in recurrence setting during salvage lymph node dissection (sLND) in patients who experience biochemical recurrence (BCR) after primary treatment and have positive PSMA positron emission tomography (PET). Near-infrared PSMA tracers, such as OTL78 and IS-002, have shown potential in intraoperative fluorescence-guided surgery, improving positive surgical margins (PSMs) and LNMs identification. Finally, augmented reality (AR), which integrates preoperative imaging (e.g., multiparametric magnetic resonance imaging [mpMRI] of the prostate and computed tomography [CT]) onto the surgical field, can provide a real-time visualization of anatomical structures through the creation of three-dimensional (3D) models. These technologies may assist surgeons during intraoperative procedures, thus optimizing the balance between oncological control and functional outcomes. However, challenges remain in standardizing these tools and assessing their impact on long-term PCa control. Overall, these advancements represent a paradigm shift toward personalized and precise surgical approaches, emphasizing the integration of innovative strategies to improve outcomes of PCa patients. Full article