The current landscape of single-port robotic surgery in urology.

The advent of the purpose-built da Vinci single-port robotic platform marks a pivotal advancement in minimally invasive urological surgery. Designed to overcome the ergonomic and technical limitations of prior single-site approaches, the single-port system enables complex procedures through a single incision, with enhanced dexterity, optimized use of confined spaces and improved cosmetic and peri-operative outcomes. The single-port system has been increasingly used across a wide range of urological indications, including robot-assisted radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation.

First-in-human transcontinental telesurgery collaboration for high intensity-focused ultrasound: a new era in globalizing focal treatment for prostate cancer.

The advent of telesurgery has opened a new frontier within minimally invasive surgery, allowing surgeons to complete procedures from a remote location and providing new opportunities for the delivery of care. Herein, we present the first clinical experience of telesurgery using high intensity-focused ultrasound (HIFU) for focal treatment of prostate cancer. The procedure was performed using the Focal One device (Focal One, Austin, TX, USA) on a 72-year-old with an ISUP Grade Group 2 prostate cancer from a single biopsy core that corresponds to a PIRADS 4 lesion in the left mid-apical region.

Development of novel patient selection algorithm for multi-port versus single-port robotic radical prostatectomy approaches.

Background: The aim of this study was to develop a patient selection algorithm to better guide clinical decision-making towards the different approaches of multi-port (MP) and single-port (SP) robotic radical prostatectomy (RARP).

Methods: A retrospective study was performed on an institutional review board (IRB) -approved database to identify all consecutive patients who underwent transperitoneal MP, extraperitoneal SP, and transvesical SP-RARP between 2018 and 2024. Baseline clinicodemographic variables were collected.

Robotic partial nephrectomy to treat large (T2) cystic renal cell carcinoma: a multi-institutional analysis (ROSULA Collaborative Group).

Purpose: To investigate the feasibility and safety of robot-assisted partial nephrectomy (RAPN) to treat large (T2) cystic renal-cell carcinoma.

Methods: A multinational study was conducted worldwide. Patients with renal tumors larger than 7cm who underwent partial nephrectomy between December 2007 and July 2017 were recruited retrospectively.

Propensity-matched Comparison of Single-port Transvesical Versus Standard Multiport Robotic Radical Prostatectomy.

Background And Objective: Introduction of the purpose-built single-port (SP) robotic platform has paved the ways for the advent of novel, regionalized surgical techniques for robot-assisted radical prostatectomy (RARP), including the SP transvesical approach. This study sought to evaluate the perioperative, oncological, and functional outcomes of transvesical SP-RARP, in comparison with the standard multiport (MP) transperitoneal technique.

Methods: A retrospective review was performed on the institutional review board-approved, prospectively maintained database to identify all consecutive patients who underwent SP transvesical and MP transperitoneal RARP between 2015 and 2024.

Association Between Midline Extraction Incision and Increased Risk of Incisional Hernia After Minimally Invasive Radical Nephrectomy: Results of an Observational Study From a High-Volume Center.

Purpose: To determine whether specimen extraction incision and body morphometry analysis of skeletal muscle and fat mass are predictive of incisional hernia (IH) after minimally invasive nephrectomy (laparoscopic or robotic).

Materials And Methods: We conducted an observational study of a prospectively maintained database of patients undergoing minimally invasive nephrectomy from 2005 to 2022. For inclusion, patients were required to have preoperative and 1-year and 2-year postoperative abdominal cross-sectional imaging.

The anesthesia impact of regionalized insufflation with transvesical single port robot-assisted radical prostatectomy.

Background: To evaluate for any differences between the intraoperative oxygenation and ventilation outcomes between single port (SP) extraperitoneal (EP) and transvesical (TV) robot-assisted radical prostatectomy (RARP) with the standard multi-port (MP) transperitoneal (TP) approach.

Methods: A retrospective review was performed on the prospectively maintained, IRB-approved database to identify 962 consecutive patients who underwent MP TP, SP EP, and SP TV RARP between 2015 and 2024. A 1:1 propensity-matched analysis was completed based on the patient's age, Body Mass Index (BMI), as well as comorbidities based on the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists' (ASA) physical status classification score.

Safety of Partial and Radical Nephrectomy for Complex Locally Advanced Renal Cell Carcinoma After Neo-Adjuvant Immune Checkpoint Inhibition: Analysis From a Phase 1b Trial (Durvalumab +/- Tremelimumab).

Objective: To determine the surgical safety after neo-adjuvant durvalumab +/- tremelimumab for patients with locally advanced renal rell carcinoma (RCC).

Methods: An open-label phase 1b trial of neoadjuvant durvalumab +/- tremelimumab in locally advanced RCC was performed at two sites between 2016-2020 (NCT02762006). Inclusion criteria included clinical stage T2b-4 and/or N1, M0 disease, ECOG 0-1, and adequate organ function.

Single Port Transvesical Robot Assisted Radical Prostatectomy.

Single-port (SP) transvesical (TV) robot-assisted radical prostatectomy (RARP) is an extraperitoneal approach that regionalizes surgery to the area of disease, therefore sparing surrounding tissues to promote a fast recovery and early return of functional outcomes. The technique is possible because of the narrow profile of the SP robotic arm, the fully wristed endoscope, and the double-jointed instruments. SP TV RARP is indicated in men with clinically localized prostate cancer.

Functional outcomes of robot-assisted partial nephrectomy in patients with a solitary kidney.

Objectives: To evaluate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) in patients with and without a solitary kidney.

Materials And Methods: A retrospective review was performed using the prospectively maintained, institutional review board-approved database to identify all consecutive patients who underwent RAPN between 2006 and 2023. A propensity-score-matched analysis was subsequently undertaken to compare patients with and without a solitary kidney.

A Fully Automated Artificial Intelligence-Based Approach to Predict Renal Function After Radical or Partial Nephrectomy.

Objective: To test if our artificial intelligence (AI)-postoperative glomerular filtration rate (GFR) prediction is as accurate as a validated clinical model. The American Urologic Association recommends estimating postoperative GFR in patients with renal masses and prioritizing partial nephrectomy (PN) when GFR would be <45 ml/minutes/1.73 m if radical nephrectomy (RN) was performed.

Percutaneous Cryotherapy and Radiofrequency Ablation of Renal Masses: Multicenter Comparative Analysis with Minimum 3-Year Follow-up.

Background: Different modalities of percutaneous thermal ablation (PTA) have been used as possible minimally invasive nephron-sparing treatments for small renal masses (SRMs). The present study aimed to compare long-term outcomes of two guidelines-recommended ablative techniques, cryotherapy (CRYO) and radiofrequency ablation (RFA).

Materials And Methods: Data of patients with single cT1 solid renal mass undergoing CRYO or RFA between 2004 and 2020 were retrospectively retrieved from a multi-institutional international database.

Development of Patient-Specific Nomogram to Assist in Clinical Decision-Making for Single Port Versus Multi-Port Robotic Partial Nephrectomy: A Report from the Single Port Advanced Robotic Consortium.

To develop a patient-specific algorithm to better guide clinical decision-making when considering between single port (SP) and multi-port (MP) robotic partial nephrectomy (RPN). A retrospective review was performed on the institutional review board-approved, prospectively maintained multi-institutional database of the Single Port Advanced Research Consortium to identify all consecutive patients who underwent SP and MP-RPN between 2019 and 2023. Baseline clinicodemographic variables were used to identify the significant predictors of SP-RPN.

Single-Port Robotic Transvesical Partial Prostatectomy: A Novel Approach for Focal Treatment in Prostate Cancer.

Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving toward precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. We analyzed a prospectively maintained database of 20 patients who underwent SP-TVRAPP between February 2021 and March 2024.

Adoption of Single-Port Robotic Partial Nephrectomy Increases Utilization of the Retroperitoneal Approach: A Report from the Single-Port Advanced Research Consortium.

Retroperitoneal approach for robotic partial nephrectomy (PN) has been shown to offer shorter operative times and hospital stays without differences in complication rates compared with the transperitoneal approach. The single-port (SP) system may be better suited than multiport (MP) for challenges with the retroperitoneal approach such as narrow access geometry. We evaluated if the adoption of SP PN increased the utilization of retroperitoneal approach.

Development and Internal Validation of a Novel Nomogram to Predict the Risk of Postoperative Acute Kidney Injury Following Robot-assisted Partial Nephrectomy.

Objective: To develop a predictive tool to assist in predicting the risk of Acute Kidney Injury (AKI) following robot-assisted partial nephrectomy (RAPN).

Methods: A retrospective review was performed on the prospectively maintained, IRB-approved database to identify all consecutive patients who underwent RAPN between 2008 and 2023. Patients with end-stage kidney disease (ESKD), horseshoe kidneys, solitary kidneys, and previous renal transplant recipients were excluded.

Low Baseline IsoPSA Index is Associated With a Prolonged Low Risk of Clinically Significant Prostate Cancer Diagnosis in Men With an Elevated PSA.

Objective: To compare the rate of diagnosing clinically significant prostate cancer (csPCa) in men with elevated prostate-specific antigen (PSA) stratified by baseline IsoPSA Index, thus assessing IsoPSA's intermediate-term predictive ability for csPCa.

Material And Methods: Single-center retrospective review of consecutive patients (n = 1578) who underwent IsoPSA testing from November 2016-August 2022. Data dichotomized into patients with low (≤6) and high IsoPSA Indices (>6).

Pure open versus robotic radical cystectomy with intracorporeal urinary diversion: a propensity matched analysis.

Objective: To compare surgical parameters and short-term outcomes between open radical cystectomy (ORC) and robotic radical cystectomy with total intracorporeal urinary diversion (icRARC).

Methods: Among the study period, 133 patients who underwent ORC and pelvic node dissection for bladder cancer (group 1) were matched and compared to 61 patients who underwent icRARC during the same period (group 2). The groups were matched 1:1 according to their propensity scores adjusted on their baseline demographics and disease characteristics.