Advancements in Minimally Invasive Urologic Surgery

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 7127

Special Issue Editors


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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

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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

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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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Research

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10 pages, 921 KiB  
Article
Follow-Up of Men Who Have Undergone Focal Therapy for Prostate Cancer with HIFU—A Real-World Experience
by Katharina Sophie Mala, Henning Plage, Lukas Mödl, Sebastian Hofbauer, Frank Friedersdorff, Martin Schostak, Kurt Miller, Thorsten Schlomm and Hannes Cash
J. Clin. Med. 2023, 12(22), 7089; https://doi.org/10.3390/jcm12227089 - 14 Nov 2023
Viewed by 1183
Abstract
Purpose: To determine oncological and functional outcomes and side effects after focal therapy of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU). Methods: This retrospective single-center study included 57 consecutive patients with localised PCa. Aged 18–80 with ≤2 suspicious lesions on mpMRI (PIRADS [...] Read more.
Purpose: To determine oncological and functional outcomes and side effects after focal therapy of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU). Methods: This retrospective single-center study included 57 consecutive patients with localised PCa. Aged 18–80 with ≤2 suspicious lesions on mpMRI (PIRADS ≥ 3), PSA of ≤15 ng/mL, and an ISUP GG of ≤2. HIFU was performed between November 2014 and September 2018. All men had an MRI/US fusion-guided targeted biopsy (TB) combined with a TRUS-guided 10-core systematic biopsy (SB) prior to focal therapy. HIFU treatment was performed as focal, partial, or hemiablative, depending on the prior histopathology. Follow-up included Questionnaires (IIEF-5, ICIQ, and IPSS), prostate-specific antigen (PSA) measurement, follow-up mpMRI, and follow-up biopsies. Results: The median age of the cohort was 72 years (IQR 64–76), and the median PSA value before HIFU was 7.3 ng/mL (IQR 5.75–10.39 ng/mL). The median follow-up was 27.5 (IQR 23–41) months. At the time of the follow-up, the median PSA value was 2.5 ng/mL (IQR 0.94–4.96 ng/mL), which shows a significant decrease (p < 0.001). In 17 (29.8%) men, mpMRI revealed a suspicious lesion, and 19 (33.3%) men had a positive biopsy result. Only IIEF values significantly decreased from 16 (IQR 10.75–20.25) to 11.5 (IQR 4.5–17) (p < 0.001). The rate of post-HIFU complications was low, at 19.3% (11 patients). The limitation of this study is the lack of long-term follow-up. Conclusions: HIFU as a therapy option for nonmetastatic, significant prostate cancer is effective in the short term for carefully selected patients and shows a low risk of adverse events and side effects. Full article
(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)
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9 pages, 552 KiB  
Article
Laparoscopic or Open Adrenalectomy for Stage I–II Adrenocortical Carcinoma: A Retrospective Study
by Martin Gaillard, Meva Razafinimanana, Alexandre Challine, Raphael L. C. Araujo, Rossella Libé, Mathilde Sibony, Maxime Barat, Jérôme Bertherat, Bertrand Dousset, David Fuks and Sebastien Gaujoux
J. Clin. Med. 2023, 12(11), 3698; https://doi.org/10.3390/jcm12113698 - 26 May 2023
Cited by 1 | Viewed by 937
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 [...] Read more.
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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8 pages, 230 KiB  
Article
First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy
by 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 6 | Viewed by 1555
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 [...] Read more.
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)

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9 pages, 258 KiB  
Systematic Review
Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review
by Senol Tonyali, Mehmet Yilmaz, Lazaros Tzelves, Esteban Emiliani, Vincent De Coninck, Etienne Xavier Keller and Arkadiusz Miernik
J. Clin. Med. 2023, 12(10), 3603; https://doi.org/10.3390/jcm12103603 - 22 May 2023
Cited by 2 | Viewed by 1623
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 [...] Read more.
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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10 pages, 994 KiB  
Case Report
Application of Indocyanine Green in Combination with Da Vinci Xi Robot in Surgeries on the Upper Urinary Tract: A Case Series Study
by Sheng Zeng, Shaoqiang Xing, Wenzhou Xing, Zhijie Bai, Jingyuan Zhang, Yanan Li, Haifeng Wang and Qian Liu
J. Clin. Med. 2023, 12(5), 1980; https://doi.org/10.3390/jcm12051980 - 02 Mar 2023
Cited by 2 | Viewed by 1411
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 [...] Read more.
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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