Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

Abstract

(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.

Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study

“…Compared with open surgery, laparoscopic surgery has been proven to have identical long-term oncologic outcomes 4 – 7 and added benefits, such as shorter hospital stays, lower analgesic requirements 8 , 9 , and shorter convalescence times. Therefore, despite the widespread use of robotic surgery, the purely laparoscopic approach is still considered the treatment of choice for many benign and malignant diseases, including complex cases for which surgery 10 , such as general and endocrine surgery, as well as urologic surgery (0.7–5.4%) may be difficult. Nevertheless, potentially life-threatening complications during laparoscopic renal and adrenal surgery, including bowel injury (0.8%) 11 , spleen injury (1.4%), pancreatic injury (0.4%) 12 , diaphragmatic injury (0.6%) 13 , 14 , and vascular complications (0.7–5.4%) are still being reported 15 .…”