Concomitant Robot-Assisted Laparoscopic Surgeries for Upper and Lower Urinary Tract Malignancies: A Comprehensive Literature Review - Beyond the Abstract

During the last two decades, we have witnessed a worldwide spreading of Robot-Assisted Laparoscopic Surgery (RALS) in urology, particularly in the oncology field. Within the urological community, RALS represents nowadays the reference standard approach for the surgical treatment of prostate and renal tumors and robot-assisted radical cystectomy is currently gaining an increasing consensus.1


It is well-known that RALS improves motion agility, optical magnification and the capacity to perform tremor-less manoeuvers compared to traditional open and pure laparoscopic approaches. These features converted in a decrease of blood loss and length of hospital stays, making RALS an appealing option for experienced surgeons to deal with challenging cases.2 The diagnosis of a concomitant primary urological cancer in patients receiving radiological staging workup has increased by 1.5%.3,4 Such a cases have been traditionally treated with staged surgeries. Recently, synchronous surgical treatment of multi-organ malignances has been proposed.5 This approach could represent a valid alternative to multiple sequential surgeries, with an objective of reducing postoperative morbidity and total costs.6

We presented a comprehensive literature review of single-session renal and prostate/bladder cancer robotic-assisted surgery.7 Single session, concomitant multiple quadrant robotic urological surgery is feasible and facilitated through the use of the Da Vinci Surgical System platform, with an acceptable complication rate and oncological outcomes. This is of paramount importance in these difficult times during the COVID-19 pandemic since surgical departments had to re-organize surgical activities prioritizing urgent intervention and non-deferrable oncological patients. In this context having the opportunity, in specifically selected patients, of combining two procedures during the same surgical setting could further help facing the emergency efficiently retrieving resources to provide effective care to high priority non-COVID-19 related diseases.

In conclusion, this review can be used to guide robotic surgeons who are willing to embrace this approach that requires a careful preoperative assessment and surgical planning to reduce morbidity and enhance postoperative recovery

Written by: Simone Scarcella, Daniele Castellani, Giulio Milanese, Andrea B.Galosi

  • Department of Urology, Polytechnic University of the Marche Region, Umberto I Hospital, Ancona, Italy.

References:

  1. Mearini, E.; Cirocchi, R.; Cochetti, G. Robot-assisted surgery in urology: The show must go on. Appl. Sci.2019, 9, 844.
  2. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4.
  3. Bray, F.; Ferlay, J.; Soerjomataram, I.; Siegel, R.L.; Torre, L.A.; Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J. Clin. 2018, 68, 394–424.
  4. Ozsoy, O.; Fioretta, G.; Ares, C.; Miralbell, R. Incidental detection of synchronous primary tumours during staging workup for prostate cancer. Swiss Med. Wkly. 2010, 140, 233–236.
  5. Piccoli, M., Esposito, S., Pecchini, F. et al. Full robotic multivisceral resections: the Modena experience and literature review. Updates Surg (2021).  https://doi.org/10.1007/s13304-020-00939-8
  6. Pullatt R, White BL (2020) Development and current state of robotic surgery. In: Living with robot. Amsterdam: Elsevier Inc. Doi: https ://doi.org/10.1016/B978-0-12-81536 7-3.00005 -0
  7. Scarcella S, Castellani D, Piazza P, Giulioni C, Sarchi L, Amato M, Bravi CA, Lores MP, Farinha R, Knipper S, Palagonia E, Skrobot SA, Develtere D, Berquin C, Sinatti C, Van Puyvelde H, De Groote R, Umari P, De Naeyer G, Dell'Atti L, Milanese G, Puliatti S, Teoh JY, B Galosi A, Mottrie A. Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review. J Robot Surg. 2021 Nov 8. doi: 10.1007/s11701-021-01317-1. Epub ahead of print. PMID: 34748165.

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