Guest editorial: robotic techniques in urologic oncology

Abstract

It is our pleasure to be Guest Editors for this issue of theWorld Journal of Urology focusing on robotic techniquesin urologic oncology. It is interesting to reflect on theintegration of laparoscopic and robotic technology in uro-logic oncology over the past 10 years. Although driven bymany factors, including market and financial forces, wethink the primary driver was interest in improved out-comes, particularly less pain, blood loss and the shorterhospital stays possible with minimally invasive surgery.Many of us who were early adopters of laparoscopictechniques in urologic oncology recognized that extirpativeprocedures (nephrectomy and prostatectomy) were rela-tively straightforward laparoscopically with adequatetraining and experience. However, reconstructive proce-dures, vesicourethral anastomosis, partial nephrectomyrenorrhaphy, and intracorporeal diversion remained diffi-cult. So, the robotic platform, with its wristed instrumentsand stable surgeon-controlled camera, gave us an attractivetool to expand the benefits of minimally invasive surgery tomore complex procedures. This issue offers some excellentreviews and original contributions spanning the range ofthe current extensive integration of robotic technology andurologic oncology techniques.The article by Drs. Mirheydar and Parsons is a pro-vocative analysis of the safety of new technology integra-tion. We should embrace more standardized training andbetter competency assessments prior to credentialingsurgeons for new procedures. We also have outstandingcontributions concerning graded nerve sparing and out-comes of robotic-assisted radical prostatectomy (RALP) byTewari et al., a clinical study by Nunez-Nateras et al. ofnovel new microporous polysaccharide hemispheres forhemostasis, a study of the impact of minimizing tensionduring nerve sparing by Kowalczyk et al., and an update onthe most extensive series of extraperitoneal RALP in theliterature by Ploussard et al. Our group (Liss et al.) ana-lyzes the outcomes and complications of standard andextended pelvic lymph node dissection during RALP. Alsoincluded in the prostate section is an excellent review ofthe outcomes of robotic salvage prostatectomy by Drs.Wetherell, Bolton and colleagues.Patel et al. provide a thorough analysis of the outcomesand complications of retroperitoneal robotic partialnephrectomy by one of the most experienced surgeonsusing this technique.Two articles concerning the robotic radical cystectomyand urinary diversion are included: a review of the litera-ture by Drs. Liss and Kader, and a summary of the com-plications and recommendations to avoid them by one ofthe most experienced groups in the world led by Dr. Pruthi.We hope these articles add to your knowledge andenhance the outcomes and safety of the urologic canceroperations that you perform.