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Special Issue "Advancements in Minimally Invasive Urologic Surgery"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (24 September 2023) | Viewed by 4265

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Special Issue Editors

Dr. Clemens M. Rosenbaum

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Guest Editor

Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
Interests: reconstructive urology; urethral stricture disease; uro-oncology; prostate cancer; bladder cancer; benign prostate hyperplasia; minimal invasive surgical treatments

Dr. Benedikt Becker

E-Mail Website
Guest Editor

Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
Interests: endourology; minimally invasive treatments; laser therapy; urolithiasis; benign prostate hyperplasia

Special Issue Information

Dear Colleagues,

Since it first emerged, urology has been a main driver of surgical innovations and technological developments, e.g., transurethral procedures for benign prostate hyperplasia and stone treatment, as well as robotic surgery or focal therapy.

As a minimally invasive treatment of benign prostate hyperplasia, laser-based surgery has pretty much become the new gold standard and entered into all guidelines. The use of new-generation pulsed thulium lasers or MOSES technology represents the latest development in the field, and they seem to outperform previous energy sources. Other surgical options such as water-based treatments (Rezum, Aquablation) and further minimally invasive procedures such as prostate artery embolization, iTIND or UroLift are also entering the market.

In uro-oncology, robotic surgery represents the latest development with new systems and operative access methods and is already a well-established tool for treating prostate and kidney cancer. However, for radical cystectomy, robotic surgery is only just about to gain widespread acceptance and is currently being investigated in ongoing studies.

All these approaches have the same goal of improving patients’ quality of life, shortening hospital stays, and reducing complication rates.

This Special Issue aims to provide an overview of the latest advancements in minimally invasive urologic surgery. We investigate not only future directions but also potential dead ends and meanders of this fascinating journey.

Dr. Clemens M. Rosenbaum
Dr. Benedikt Becker
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

endourology
minimally invasive surgical treatments
benign prostate hyperplasia
robotic surgery
urinary stone disease
uro-oncology
focal therapy
laparoscopic surgery

Published Papers (5 papers)

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Open AccessArticle

Laparoscopic or Open Adrenalectomy for Stage I–II Adrenocortical Carcinoma: A Retrospective Study

and

J. Clin. Med. 2023, 12(11), 3698; https://doi.org/10.3390/jcm12113698 - 26 May 2023

Viewed by 535

Abstract

Surgical resection of adrenocortical carcinoma (ACC) is the only curative treatment. Even in localized (I–II) stages, open adrenalectomy (OA) is the gold standard, though laparoscopic adrenalectomy (LA) can be proposed in selected patients. Despite the postoperative benefits of LA, its role in the surgical management of patients with ACC remains controversial regarding oncologic outcomes. The aim of this retrospective study was to compare the outcomes of patients with localized ACC submitted to LA or OA in a referral center from 1995 to 2020. Among 180 consecutive patients operated on for ACC, 49 presented with localized ACC (19 LA and 30 OA). Baseline characteristics were similar between groups, except for tumor size. Kaplan-Meier estimates of 5-year overall survival were similar in both groups (p = 0.166) but 3-year disease-free survival was in favor of OA (p = 0.020). Though LA could be proposed in highly selected patients, OA should still be considered the standard approach in patients with known or suspected localized ACC. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

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Open AccessArticle

First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy

Julius Bergmann

Clemens Mathias Rosenbaum

Christopher Netsch

Andreas J. Gross

and

Benedikt Becker

J. Clin. Med. 2023, 12(7), 2588; https://doi.org/10.3390/jcm12072588 - 29 Mar 2023

Cited by 1 | Viewed by 977

Abstract

Introduction: Laser lithotripsy during Mini-PCNL is one treatment option in urinary stone disease. In recent years, a new era in stone treatment has been initiated with the introduction of new pulsed thulium lasers. The aim of this study was to investigate the safety and efficacy of laser lithotripsy with a new pulsed solid-state thulium:YAG laser during mini-PCNL. Materials and methods: All patients, regardless of stone size, who were treated with a Mini-PCNL using the new pulsed thulium laser were prospectively enrolled. Operation times, stone size, laser time, and laser settings were noted. The stone-free rate was assessed postoperatively with sonography and either X-ray or computed tomography as a clinical standard. The complications were analyzed using the Clavien-Dindo classification. Results: A total of 50 patients with a mean age of 52 years were included. 31 (62 %) patients were male. The average stone size was 242.3 (±233.1) mm² with an average density of 833 (±325) Hounsfield units. The mean operating time was 30.56 (±28.65) min, and the laser-on-time was 07:07 (± 07:08) min. The most commonly used settings were 0.4 J and 115 Hz (46 W). The mean total energy for stone ablation was 14,166 (±17,131) kJ. The total stone-free rate was 84 %, with an overall complication rate of 32% according to Clavien-Dindo (grade 1: n = 9, grade 2: n = 6, 3b: n = 1). In the group of patients with singular stones (n = 25), the stone-free rate was 88%. Summary: The new pulsed solid-state Thulium:YAG laser allows a safe and effective lithotripsy during Mini-PCNL. The stone-free rates were high regardless of stone size with a comparable low rate of complications. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

Open AccessArticle

Influence of Prostate Cancer on Thulium Vapoenucleation of the Prostate—A Multicentre Analysis

and

Clemens Mathias Rosenbaum

J. Clin. Med. 2023, 12(3), 1174; https://doi.org/10.3390/jcm12031174 - 01 Feb 2023

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Abstract

Purpose: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common in elderly men. Data on the laser-based surgery known as thulium vapoenucleation of the prostate (ThuVEP) in PCa patients are rare. Our objective was to analyse the feasibility, safety and functional outcome of ThuVEP in patients with lower urinary tract symptoms (LUTS) and PCa. Methods: Multicentre study, including 1256 men who underwent ThuVEP for LUTS. Maximum urinary flow rate (Qmax) and post-void residual volume (PVR) were measured perioperatively. The International Prostate Symptome Score (IPSS) was measured perioperatively and at follow-up (FU). Perioperative complications were captured. Reoperation rate was captured at FU. Results: Of 994 men with complete data, 286 (28.8%) patients had PCa. The most common Gleason score was 3 + 3 in 142 patients (49.7%). Most common was low-risk PCa (141 pts; 49.3%). PCa patients were older, had smaller prostates and had higher prostate-specific antigen (PSA) values (all p < 0.001). Comparing non-PCa and PCa patients, no differences occurred perioperatively. IPSS, quality of life and PVR decreased (all p < 0.001) and Qmax improved (p < 0.001) in both groups. Reoperation rates did not differ. The results of low- vs. intermediate-/high-risk PCa patients were comparable. Conclusion: ThuVEP is a safe and long-lasting treatment option for patients with LUTS with or without PCa. No differences occurred when comparing low- to intermediate-/high-risk PCa patients. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

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Open AccessSystematic Review

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

Etienne Xavier Keller

and

Arkadiusz Miernik

J. Clin. Med. 2023, 12(10), 3603; https://doi.org/10.3390/jcm12103603 - 22 May 2023

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Abstract

Background: The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords “ureteral stone”, “ureteral calculus”, “impacted stone”, “ureteral stenosis”, “ureteroscopic lithotripsy”, “impacted calculus”, and “ureteral strictures” singly or in combination. Results: After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. Conclusion: Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

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Open AccessCase Report

Application of Indocyanine Green in Combination with Da Vinci Xi Robot in Surgeries on the Upper Urinary Tract: A Case Series Study

and

J. Clin. Med. 2023, 12(5), 1980; https://doi.org/10.3390/jcm12051980 - 02 Mar 2023

Cited by 2 | Viewed by 1002

Abstract

Background: To explore the application value of intraoperative imaging by indocyanine green (ICG) injection through the collection system of the urinary tract for Da Vinci Xi robot navigation in complex surgeries on the upper urinary tract. Methods: Data of 14 patients who underwent complex surgeries of the upper urinary tract post-ICG injection through the collection system of the urinary tract in combination with Da Vinci Xi robot navigation in the Tianjin First Central Hospital between December 2019 and October 2021 were analyzed in this retrospective study. The operation duration, estimated blood loss, and exposure time of ureteral stricture to ICG were evaluated. The renal functions and tumor relapse were evaluated after surgery. Results: Of the fourteen patients, three had distal ureteral stricture, five had ureteropelvic junction obstruction, four presented duplicate kidney and ureter, one had a giant ureter, and one presented an ipsilateral native ureteral tumor after renal transplantation. The surgeries in all patients were successful, with no conversion to open surgery. In addition, no injury to the surrounding organs, anastomotic stenosis or leakage, or ICG injection-related side effects were detected. Imaging at 3 months post-operatively revealed improved renal functions compared to those before the operation. No tumor recurrence or metastasis was observed in patient 14. Conclusion: Fluorescence imaging compensating for the inadequacy of tactile feedback in the surgical operating system has advantages in identifying the ureter, determining the site of ureteral stricture, and protecting the blood flow for the ureter. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

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