Robotic-assisted surgery for the treatment of urologic cancers: recent advances

Falagario, Ugo Giovanni; Veccia, Alessandro; Weprin, Samuel; Albuquerque, Emanuel V.; Nahas, William Carlos; Carrieri, Giuseppe; Pansadoro, Vito; Hampton, Lance J.; Porpiglia, Francesco; Autorino, Riccardo

doi:10.1080/17434440.2020.1762487

Cited by 44 publications

(30 citation statements)

References 96 publications

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“…Urologists have always shown a relevant interest in minimally invasive surgery, from the initial spread of laparoscopy to the current explosion of robotic surgery, especially in the management of genitourinary cancers over the past 10 years. 1 Particularly, the robotic approach has gained popularity manly because of the potential expected advantages of a minimally invasive approach, especially in terms of morbidity and quality of life (QoL). Due to the intrinsic complexity of performing a totally intracorporeal urinary diversion (i-UD), longer operative times (OTs) were the main drivers against a widespread adoption of robot-assisted radical cystectomy (RARC).…”

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confidence: 99%

Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial

et al. 2022

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Introduction: Radical cystectomy (RC) with urinary diversion (UD) is still considered a complex surgery associated with significant morbidity. Open RC (ORC) remains the reference option of treatment, even if adoption of robot-assisted RC (RARC) is rapidly increasing. To date, all the available randomized controlled trials were characterized by an extracorporeal approach in performing UD, undermining potential benefits of a totally minimally invasive procedure. In this study, we aimed to report perioperative and 6-month outcomes from the first RCT comparing ORC and RARC with totally intracorporeal UD. Methods: Patients were eligible for randomization if they had a diagnostic transurethral resection of bladder tumor with cT2-4, cN0, cM0, or recurrent high-grade nonmuscle-invasive bladder cancer and no anesthesiologic contraindications to robotic surgery. Patients were enrolled with a covariate adaptive randomization process based on the following variables: body mass index, American Society of AnesthesiologistsÒ score, baseline haemoglobin, planned UD, neoadjuvant chemotherapy and cT-stage. The primary end point was to demonstrate the superiority of RARC with intracorporeal UD in terms of a 50% transfusions rate's reduction. Results: Overall, 116 consecutive patients (58 RARC, 58 ORC) were enrolled. Among primary endpoint, overall perioperative transfusion rates were significantly lower in the RARC cohort (RARC: 22% vs ORC: 41%; p[0.046). Conclusions: This prospective randomized trial observed 22% and 41% overall perioperative transfusion rates in patients treated by RARC and ORC, respectively, confirming a significant benefit in favor of RARC with intracorporeal UD. However, perioperative complications, hospital stay, and 6-month health-related quality of life were largely comparable between groups. Oncologic and functional outcomes will be assessed at longer followup to observe potential differences between arms.

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Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial

et al. 2022

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“…With the widespread use of multiparametric MR in prostate imaging, robotic partial prostatectomy has also come to the fore. 36 Lotan et al 37 suggested that 10 cases per week or 250 cases per year may be necessary for the use of robots in surgery to be cost-effective. The difficulties to overcome in robotic surgery are: occupying a lot of room in the operating room, long preparation time, long training time, and low return on investment.…”

Section: The Future Of Robotic Systems In Urologymentioning

confidence: 99%

“…New modalities that tried to be integrated into robotic surgery are 3D reconstruction, indocyanine green (ICG), augmented reality, and contrast ultrasound. 36 Virtual reality applications in robotic surgery training are frequently preferred, because they increase surgical ability, decrease the operation time, and reduce intraoperative errors. 38 However, mixed reality applications, which combine the real and virtual worlds, are considered as a more suitable option, as VR may cause dizziness as a side effect.…”

Section: The Future Of Robotic Systems In Urologymentioning

confidence: 99%

Urologic Surgery in Digital Era: Foresights and Futuristic Approach

2021

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The new scientific developments and technological opportunities that have led to significant changes all build up the digital era. In medicine, the use of new technologies in patient diagnosis and treatment processes has opened new horizons for physicians and patients. As considering for the medical training, 3-dimensional modeling opportunities, virtual reality, augmented reality, and various simulators offered by the new technologies of the digital era have become a new hope. The 3-dimensional scanning and modeling, 3-dimensional medical printing, virtual reality technologies applications and simulators in urology are very recent and valuable. Besides, the exoscope-assisted 3-dimensional open surgery provides high-resolution 3-dimensional images to surgeons with high comfort as compared with old-fashioned operating microscopes. New modalities that tried to be integrated in robotic surgery are 3-dimensional reconstruction, usage of indocyanine green, augmented reality, contrast ultrasound, haptic feedback, and availability of single port. Some new companies announced their new robotic systems in the market. The use of these new technological applications during medical training, especially at the beginning of the education curve for various surgical interventions, may be beneficial in terms of reducing possible complications that may be encountered due to inexperience at the beginning of the education process and increasing patient safety. Urology will also stay at the futuristic approach in medicine, while 3-dimensional technologies used more widely in this field.

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“…This per se represents a remarkable achievement. As applications of robotics in urological surgery have tremendously expanded, 1 robot-assisted radical cystectomy (RARC) for bladder cancer treatment has gained momentum, given its proven oncological safety. 2 While in the “early/discovery” phase most groups were performing extracorporeal urinary diversions (UDs), during more recent years, thanks to maturing experience, there has certainly been a trend toward intracorporeal UDs.…”

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2022

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Available at https://www.eortc.org/app/uploads/sites/2/ 2018/02/SCmanual.pdf. 16. Dindo D, Demartines N and Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205. 17. De Nunzio C, Cindolo L, Leonardo C et al: Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort. Eur J Surg Oncol 2013; 39: 792.

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Robotic-assisted surgery for the treatment of urologic cancers: recent advances

Cited by 44 publications

References 96 publications

Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial

Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial

Urologic Surgery in Digital Era: Foresights and Futuristic Approach

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