Personalized Medicine in Minimally Invasive Urological Surgery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (10 February 2024) | Viewed by 3907

Special Issue Editors


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Guest Editor
Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
Interests: bladder cancer; urology; robotic surgery

E-Mail Website
Guest Editor
Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University Rome, 00162 Rome, Italy
Interests: Uro-oncology; Renal cancer; Urothelial cancer; Nephroureterectomy; Bladder cancer; Testis cancer; Penile cancer; Prostate cancer
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Special Issue Information

Dear Colleagues,

Modern medicine faces numerous challenges, including the tendency to swing between overtreatment and undertreatment. The challenge is striking the right balance between adequate treatment and avoiding harm. Thanks to innovations in technology and progress in our understanding of biology, personalized medicine offers a solution to this challenge by delivering the right therapy at the right time to the right patient. Personalized medicine takes into account individual differences in people’s characteristics to create a unique and effective treatment plan. This approach allows for more precise and targeted therapy, reducing the risk of overtreatment or undertreatment and improving patient outcomes.

This Special Issue of the Journal of Personalized Medicine is open to all minimally invasive surgical procedures for the treatment of either benign or malignant genitourinary diseases.

Prof. Dr. Costantino Leonardo
Dr. Antonio Tufano
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 Personalized Medicine is an international peer-reviewed open access monthly 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

  • minimally invasive surgery
  • personalized surgery
  • tailored surgery
  • robotic surgery
  • urology

Published Papers (4 papers)

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Research

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11 pages, 568 KiB  
Article
Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia Management after Radical Prostatectomy: Results from a Single Center Study
by Angelo Civitella, Francesco Prata, Rocco Papalia, Vincenzo Citriniti, Piergiorgio Tuzzolo, Giuseppe Pascarella, Ester Maria Alba Forastiere, Alberto Ragusa, Francesco Tedesco, Salvatore Mario Prata, Umberto Anceschi, Giuseppe Simone, Giovanni Muto, Roberto Mario Scarpa and Rita Cataldo
J. Pers. Med. 2023, 13(12), 1634; https://doi.org/10.3390/jpm13121634 - 23 Nov 2023
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Abstract
(1) Background: Regional anesthesia, achieved through nerve blocks, has gained widespread acceptance as an effective pain management approach. This research aimed to evaluate the efficacy of laparoscopic (LAP) transversus abdominis plane (TAP) block in patients undergoing laparoscopic radical prostatectomy. (2) Methods: From January [...] Read more.
(1) Background: Regional anesthesia, achieved through nerve blocks, has gained widespread acceptance as an effective pain management approach. This research aimed to evaluate the efficacy of laparoscopic (LAP) transversus abdominis plane (TAP) block in patients undergoing laparoscopic radical prostatectomy. (2) Methods: From January 2023 to July 2023, 60 consecutive patients undergoing minimally invasive radical prostatectomy were selected. Patients were split into two groups receiving ultrasound-guided (US) or laparoscopic-guided TAP block. The primary outcome was a pain score expressed by a 0−10 visual analog scale (VAS) during the first 72 h after surgery. (3) Results: Both LAP-TAP and US-TAP block groups were associated with lower pain scores postoperatively. No statistically significant differences were observed between the two groups in surgery time, blood loss, time to ambulation, length of stay, and pain after surgery (all p > 0.2). In the LAP-TAP block group, the overall operating room time was significantly shorter than in the US-TAP block group (140 vs. 152 min, p = 0.04). (4) Conclusions: The laparoscopic approach, compared to the US-TAP block, was equally safe and not inferior in reducing analgesic drug use postoperatively. Moreover, the intraoperative LAP-TAP block seems to be a time-sparing procedure that could be recommended when patient-controlled analgesia cannot be delivered. Full article
(This article belongs to the Special Issue Personalized Medicine in Minimally Invasive Urological Surgery)
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11 pages, 4640 KiB  
Article
Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings
by Francesco Prata, Gianluigi Raso, Alberto Ragusa, Andrea Iannuzzi, Francesco Tedesco, Loris Cacciatore, Angelo Civitella, Piergiorgio Tuzzolo, Giuseppe D’Addurno, Pasquale Callè, Salvatore Basile, Marco Fantozzi, Matteo Pira, Salvatore Mario Prata, Umberto Anceschi, Giuseppe Simone, Roberto Mario Scarpa and Rocco Papalia
J. Pers. Med. 2023, 13(9), 1372; https://doi.org/10.3390/jpm13091372 - 13 Sep 2023
Cited by 4 | Viewed by 1096
Abstract
The current literature relating to the novel HugoTM RAS System lacks consistent data concerning the bedside features of robot-assisted partial nephrectomy (RAPN). To describe the trocar placement and docking settings for RAPN with a three-arm configuration to streamline the procedure with Hugo [...] Read more.
The current literature relating to the novel HugoTM RAS System lacks consistent data concerning the bedside features of robot-assisted partial nephrectomy (RAPN). To describe the trocar placement and docking settings for RAPN with a three-arm configuration to streamline the procedure with HugoTM RAS, between October 2022 and April 2023, twenty-five consecutive off-clamp RAPNs for renal tumors with the HugoTM RAS System were performed. We conceived a trouble-free three-arm setting to ease and standardize RAPN trocar placement and docking settings with HugoTM RAS. Perioperative data were collected. Post-operative complications were reported according to the Clavien–Dindo classification. The eGFR was calculated according to the CKD–EPI formula. Continuous variables were presented as the median and IQR, while frequencies were reported as categorical variables. Off-clamp RAPNs were successfully performed in all cases without the need for conversion or additional port placement. The median age and BMI were 69 years (IQR, 60–73) and 27.3 kg/m2 (IQR, 25.7–28.1), respectively. The median tumor size and R.E.N.A.L. score were 32.5 mm (IQR, 26–43.7) and 6 (IQR, 5–7), respectively. Two patients were affected by cT2 renal tumors. The median docking and console time were 5 (IQR, 5–6) and 90 min (IQR, 68–135.75 min), respectively, with slightly progressive improvements in the docking time achieved. No intraoperative complications occurred alongside clashes between instruments or with the bed assistant. In experienced hands, this simplified three-instrument configuration of the HugoTM RAS System for off-clamp RAPN resulted in feasible and safe practice, providing patient-tailored trocar placement and docking with non-inferior peri-perioperative outcomes to other robotic platforms. Full article
(This article belongs to the Special Issue Personalized Medicine in Minimally Invasive Urological Surgery)
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12 pages, 1496 KiB  
Article
“Single Knot–Single Running Suture” Vesicourethral Anastomosis with Posterior Musculofascial Reconstruction during Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide of Surgical Technique
by Rocco Simone Flammia, Eugenio Bologna, Umberto Anceschi, Antonio Tufano, Leslie Claire Licari, Luca Antonelli, Flavia Proietti, Federico Alviani, Michele Gallucci, Giuseppe Simone and Costantino Leonardo
J. Pers. Med. 2023, 13(7), 1072; https://doi.org/10.3390/jpm13071072 - 29 Jun 2023
Cited by 1 | Viewed by 987
Abstract
Background: Our aim is to describe Gallucci’s (VV-G) technique for vesicourethral anastomosis and posterior musculofascial reconstruction (PMFR) during robot-assisted radical prostatectomy (RARP) and to assess early urinary continence recovery and perioperative outcomes. VV-G consists of a “single knot–single running suture” vesicourethral anastomosis with [...] Read more.
Background: Our aim is to describe Gallucci’s (VV-G) technique for vesicourethral anastomosis and posterior musculofascial reconstruction (PMFR) during robot-assisted radical prostatectomy (RARP) and to assess early urinary continence recovery and perioperative outcomes. VV-G consists of a “single knot–single running suture” vesicourethral anastomosis with PMFR. Methods: Between September 2019 and October 2021, we prospectively compared VV-G vs. conventional Van Velthoven anastomosis (VV-STD) during RARP. We excluded patients with urinary incontinence, pelvic radiotherapy, and urethral and BPH surgery prior to RARP. Social continence (SC) recovery, perioperative complications, and length of hospital stay (LOS) were compared between VV-G vs. VV-STD. SC was defined as 0–1 pad/die. We applied 1:1 propensity score matching (PSM) adjusting for different covariates (age, Charlson Comorbidity Index, BMI, prostate volume, nerve-sparing and lymph node dissection). Results: From 166 patients, 1:1 PSM resulted in two equally sized groups of 40 patients each with no residual differences (all p ≥ 0.2). VV-G yielded higher 3-month SC rates than VV-STD (97.5 vs. 55.0%, p < 0.001). A tiny difference was still recorded at one-year follow-up (97.5 vs. 80.0%, p = 0.029, HR: 2.90, 95% CI: 1.74–4.85, p < 0.001). Conversely, we observed no differences in any perioperative complications (15.0 vs. 22.5%, OR: 0.61, 95% CI 0.19–1.88, p = 0.4) and LOS (3 vs. 4 days, Δ: −0.69 ± 0.61, p = 0.1). Conclusions: VV-G significantly improved early SC recovery without increasing perioperative morbidity. In our opinion, VV-G represents an easy-to-learn and easy-to-teach technique due to its single-suture, single-knot, and symmetrical design. Full article
(This article belongs to the Special Issue Personalized Medicine in Minimally Invasive Urological Surgery)
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Review

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22 pages, 2056 KiB  
Review
Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney
by Yarden Zohar, Bezalel Sivan, Ishai Mintz, Ben Hefer, Keren Rouvinov, Noa Shani Shrem and Nicola J. Mabjeesh
J. Pers. Med. 2024, 14(2), 158; https://doi.org/10.3390/jpm14020158 - 30 Jan 2024
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Abstract
Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted [...] Read more.
Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC. Full article
(This article belongs to the Special Issue Personalized Medicine in Minimally Invasive Urological Surgery)
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