Totally intracorporeal robot-assisted urinary diversion for bladder cancer(part 2).Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder

Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.

Single-port technique evolution and current practice in urologic procedures

Different groups described the single-port surgery since its first report in laparoscopic procedures.However,the acceptance of this technique among urologists,even after the robotic approach,was reduced in the past years.Therefore,to overcome the challenges related to the single-port surgery,a new robotic platform named da Vinci SP was created with exclusive single port technology.We performed a non-systematic literature review regarding the single port technique in urologic surgeries since the first laparoscopic report until the da Vinci SP robotic platform.Three different periods were described(laparoscopy,robotic,and da Vinci SP),and we focused in our experience with this new single port robot.We selected different articles and summarized the information regarding the use of single-site surgery in laparoscopic procedures and the challenges of this approach.We also reported the experience of different groups using the single port robotic technique and some recent reports of the da Vinci SP approach.In our experience with this new console,we described some critical points related to our radical prostatectomy technique and the lessons learned during the introduction of this novel platform.Previous single-site procedures described some common challenges that limited the technique expansion.However,our experience with the da Vinci SP described feasible and safe procedures with acceptable intraoperative outcomes.The introduction of this platform is recent in the market,and the literature still lacks a high level of evidence describing the long-term outcomes of this new technology.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch

Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was performed.Results:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the analysis.Regarding ICIC,the patients’age ranged from 60 to 76 years.The operative time to perform a urinary diversion ranged from 60 to 133 min.The total estimated blood loss ranged from 200 to 1117 mL.The rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,respectively.Late minor and major complication rates ranged from 0%to 66%and from 0%to 32%,respectively.Totally ICIP data are limited to one case report and one clinical series.Conclusion:The most frequent type of CUD is ICIC.Randomized studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature.To this day,there are not enough quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique.

Magnetic resonance imaging-guided prostate biopsydA review of literature

Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.

Robotic surgery techniques to approach benign prostatic hyperplasia disease:A comprehensive literature review and the state of art

Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple prostatectomy.Since the first report,RASP underwent several technical modifications.The study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia(BPH).Methods:The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020,assessing robot-assisted surgical techniques for BPH treatment using the terms“robot-assisted simple prostatectomy”OR“robotic simple prostatectomy”OR“RASP”AND“surgical technique”.Results:After careful review of 180 studies in PubMed and 198 in Embase,16 papers reporting different RASP techniques.After the first procedure described by Sotelo et al.[9],several authors contributed to the development of the RASP technique.John et al.[24]proposed the extraperitoneal access,and Yuh et al.[23]first reported the adenoma transcapsular dissection.Some modifications were proposed by Coelho et al.[31]on trigonization,posterior reconstruction,and urethro-vesical anastomosis.Other groups focused on urethral-preserving procedures.Moschovas et al.[28]and Clavijo et al.[32]recently described an intrafascial RASP with the removal of the entire prostatic tissue.Finally,Kaouk et al.[29]reported the feasibility and safety of the da Vinci Single Port approach.Conclusion:In the last eighteen years,the robotic-assisted approach to BPH disease has been evolved,and different techniques have been described.This review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.

Robotic renal and adrenal oncologic surgery:A contemporary review

Robot-assisted surgery has evolved over time.Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I,II and III thrombus in high volume centers.Though it is feasible for level IV thrombus,this procedure needs a multi-departmental cooperation.However,the safety of robot-assisted procedures in this subset is still unknown.Robot-assisted partial nephrectomy has been universally approved and found oncologically safe.Robotic adrenalectomy has been increasingly utilized for select cases,especially in bilateral tumors and for retroperitoneal adrenalectomy.

Robot-assisted endoscopic inguinal lymphadenectomy:A review of current outcomes

Objective:To review the role of robot-assisted endoscopic inguinal lymphadenectomy(RAIL)in the management of penile cancer.Methods:A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword“robotic”,“inguinal lymph node dissection”,and“penile cancer”.Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor.Results:We identified 23 articles,of note the three largest series that included 102,27,and 20 RAIL in 51,14,and 10 patients,respectively.Saphenous vein was spared in 88.93%of RAIL cases in these series and node yield was 11.42 per groin;35.28%of patients had positive pathological nodes.The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient.The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days;the major complication rate was only 5.31%in these series.The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%.Conclusion:The literature regarding RAIL describes promising results,although it has shorter follow-up and higher costs when compared to historically series from the open approach.Initials series reported lower cutaneous complications compared to conventional approach,without compromising oncological outcomes.However,long-term results and larger trials are crucial to validate those findings.

Robtic-assisted radical cystectomy:Literature review

Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of progression.Also,the robotic approach to this type of surgery is well established in the literature.Our objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate cancer.We performed a literature review of articles describing the robotic approach to RC in patients with bladder cancer.Also,we described the procedure since the patient selection until the bladder removal.The reconstructive techniques were not included in this review.Twenty-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols,surgical technique,pathology report,oncological outcomes,complication rates,and quality of life after the procedure.Robotic-assisted radical cystectomy is feasible and safe with satisfactory oncological outcomes.The robotic approach is related to lower blood loss and fewer transfusion rates.However,when compared to open surgery,the use of this technology increases the operative time.

The robot-assisted ureteral reconstruction in adult:A narrative review on the surgical techniques and contemporary outcomes

Despite the rapid increase in the use of robotic surgery in urology,the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches.This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones,and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems.However,with the potential benefits of minimal invasiveness,several pioneering reports have been published on robotic surgery in urology.By reviewing the literature on this topic,we aimed to summarize the techniques,considerations,and consistent findings regarding robotic ureteral reconstruction in adults.Robotic applications for ureteral surgery have been primarily reported for pediatric urology,especially in the context of relieving a congenital obstruction in the ureteral pelvic junction.However,contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant,iatrogenic,and traumatic conditions,which generally occur in adult patients.Nevertheless,the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population;thus,qualified prospective trials are needed for wider acceptance.However,contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction,even in the absence of haptic feedback,which can be compensated by various surgical techniques and enhanced three-dimensional visualization.

Robot-assisted retroperitoneal lymphadenectomy:The state of art

Objective:To perform a narrative review about the role of robot-assisted retroperitoneal lymphadenectomy(R-RPLND)in the management of testicular cancer.Methods:A PubMed search for all relevant publications regarding the R-RPLND series up until August 2019 was performed.The largest series were identified,and weighted means calculated for outcomes using the number of patients included in each study as the weighting factor.Results:Fifty-six articles of R-RPLND were identified and eight series with more than 10 patients in each were included.The weighted mean age was 31.12 years;primary and post chemotherapy R-RPLND were performed in 50.59%and 49.41%of patients.The clinical stage was I,II and III in 47.20%,39.57%and 13.23%of patients.A modified R-RPLND template was used in 78.02%of patients,while 21.98%underwent bilateral full template.The weighted mean node yield,operative time and estimated blood loss were,respectively,22.15 nodes,277.35 min and 131.94 mL.The weighted mean length of hospital stay was 2 days and antegrade ejaculation was preserved in 92.12%of patients.Major post-operative complications(Clavien III or IV)occurred in 5.34%.Positive pathological nodes were detected in 24.54%,while the recurrence free survival was 95.77%with a follow-up of 21.81 months.Conclusion:R-RPLND has proven to be a reproducible and safe approach in experienced centers;short-term oncologic outcomes are similar to the open approach with less morbidity and shorter convalescence related to its minimal invasiveness.However,longer follow-up and new trials comparing head-to-head both techniques are expected.

Robotic urologic surgery:Past,present and future

The robotic surgery revolution has undoubtedly changed how surgeons’and patients’view and perform surgical intervention.While this evolution in surgical technology has affected many surgical fields,it has had the most impact in the field of urologic surgery.Most intra-abdominal surgical procedures in urology are now performed robotically in the United States and Europe.