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

ABSTRACT

Introduction

As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades.

Areas covered

This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed.

Expert opinion

Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.

KEYWORDS:

• Augmented reality
• bladder cancer
• image-guided surgery
• kidney cancer
• prostate cancer
• robotic surgery
• urological cancer

Article highlights

• Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years.

• Robotic radical prostatectomy is the current gold standard surgical treatment for prostate cancer, and it has paved the way for other robotic urologic procedures.

• Robotic partial nephrectomy is rapidly becoming the preferred modality for nephron-sparing surgery, offering a minimally invasive approach also for more complex renal masses.

• For bladder cancer patients, the added value of robotic surgery seems to stem from the implementation of intracorporeal urinary diversions, which was a challenging task with standard laparoscopy.

• Evidence supporting the lymphadenectomy for less common cancers, such as testis and penile cancers, remains limited.

New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery.

Author contributions

Conception and design: Autorino, Falagario.

Acquisition of data: Falagario, Veccia, Weprin, Albuquerque.

Analysis and interpretation of data: Autorino, Falagario, Veccia, Weprin, Albuquerque.

Drafting of the manuscript: Falagario, Veccia, Weprin, Albuquerque.

Critical revision of the manuscript for important intellectual content: Autorino, Hampton, Nahas, Pansadoro, Porpiglia

Supervision: Autorino

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.