Minimally invasive surgery: PN can be used for complex tumors

Noteworthy minimally invasive surgery research from AUA 2018 also included topics such as robot-assisted versus open radical cystectomy as well as minimally invasive retroperitoneal lymph node dissection in men with testis cancer. The take-homes were presented by Jean Joseph, MD, MBA, of the University of Rochester, Rochester, NY.

• Partial nephrectomy may be considered for patients with complex renal tumors based on a large retrospective study that found no differences in 30-day complication rates or oncologic outcomes comparing it with radical nephrectomy.
• In a small study of patients with adrenocortical carcinoma, disease-free survival was superior after open adrenalectomy than after laparoscopic adrenalectomy.
• Outcomes of adrenalectomy are similar whether the procedure is performed by general surgeons (who currently perform 90% of these procedures) or urologists, supporting the idea that urologists should be performing more adrenalectomies.
• Minimally invasive partial nephrectomy can be considered instead of radical nephrectomy for select patients with large clinical T2 renal masses.
• Robot-assisted radical nephrectomy is associated with a modest improvement in perioperative outcomes compared with a laparoscopic technique.
• Minimally invasive surgery is feasible for treatment of kidney cancer with venous thrombus and associated with acceptable oncologic and functional outcomes, but a high rate of complications, even when performed by experienced hands.
• Robot-assisted cystectomy for locally advanced bladder cancer is associated with similar oncologic efficacy compared with open radical cystectomy, but adequate node dissection is important because increased lymph node yield is associated with higher survival.
• In a multicenter study with 30 months follow-up of patients operated on for muscle-invasive bladder cancer, cancer-specific survival was similar in groups undergoing robot-assisted versus open radical cystectomy, but the minimally invasive approach was associated with better perioperative outcomes (operating time, estimated blood loss, transfusion rate, length of stay, and major complications).
• A phase III randomized controlled trial found delayed ligation of the dorsal vascular complex during robot-assisted radical prostatectomy had no detrimental impact on perioperative outcomes compared with preventive ligation.
• Analysis of EPIC-26 data in patients undergoing laparoscopic radical prostatectomy, brachytherapy, or cryotherapy for localized prostate cancer showed each treatment affects quality of life, but with a unique recovery profile.
• Open and robot-assisted salvage radical prostatectomy were associated with similar complication rates in a study of patients operated on at two tertiary referral centers.
• In men with testis cancer, minimally invasive retroperitoneal lymph node dissection is done less frequently than an open approach and is associated with a higher 30-day readmission rate.
• A 3-D printed silicone vesicourethral anastomosis model exhibited realism and discriminated between expert and novice surgeons.
• Remote expert feedback using social networking was as effective as in-person feedback in helping trainees (medical students) acquire robotic skills.