Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

PURPOSE: Patients with muscle-invasive bladder cancer and concomitant upper urinary tract tumors may be candidates for simultaneous cystectomy and nephroureterectomy. Other clinical conditions such as dialysis-dependent end-stage renal disease and non-functioning kidney are also indications for simultaneous removal of the bladder and kidney. In the present study, we report our laparoscopic experience with simultaneous laparoscopic radical cystectomy (LRC) and nephroureterectomy. MATERIALS AND METHODS: Between August 2000 and June 2007, 8 patients underwent simultaneous laparoscopic radical nephroureterectomy (LNU) (unilateral-6, bilateral-2) and radical cystectomy at our institution. Demographic data, pathologic features, surgical technique and outcomes were retrospectively analyzed. RESULTS: The laparoscopic approach was technically successful in all 8 cases (7 males and 1 female) without the need for open conversion. Median total operative time, including LNU, LRC, pelvic lymphadenectomy and urinary diversion, was 9 hours (range 8-12). Median estimated blood loss and hospital stay were 755 mL (range 300-2000) and 7.5 days (range 4-90), respectively. There were no intraoperative complications but only 1 major and 2 minor postoperative complications. The overall and cancer specific survival rates were 37.5% and 87.5% respectively at a median follow-up of 9 months (range 1-45). CONCLUSIONS: Laparoscopic nephroureterectomy with concomitant cystectomy is technically feasible. Greater number of patients with a longer follow-up is required to confirm our results.

INTRODUCTION: To review the current status of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RALP) in relation to radical retropubic prostatectomy (RRP) in the management of localized prostate cancer. MATERIALS AND METHODS: Between 1982 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: retropubic, laparoscopic, robotic, robot-assisted, and radical prostatectomy. Special emphasis was given to the technical and cost considerations as well as operative, functional and oncologic outcomes. In particular, reports with pioneering work that have contributed to the evolution of the technique, presenting comparative outcomes and with large series encompassing intermediate/long term follow-up, were taken into account. RESULTS: After intermediate term follow-up, LRP and RALP achieved similar oncologic and functional results compared to RRP. However, LRP and RALP were associated with decreased blood loss, faster convalescence and better cosmetics when compared to RRP. The RALP technique is undoubtedly more expensive. CONCLUSIONS: The oncologic and functional outcomes for LRP and RALP are similar to RRP after intermediate term follow-up. Long term follow-up and adequately designed studies will determine the inherent advantages and disadvantages of the individual techniques in the management of localized prostate cancer.

Objectives: The last decade has seen tremendous growth of surgical robotics. Popularized for radical prostatectomy, robotic techniques are now increasingly being applied to radical cystectomy. Herein, we review the development and current status of robotic radical cystectomy (RRC) in contemporary urological practice. Methods: Between 1995 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: robotic, robot-assisted, laparoscopic and cystectomy. Since the first report in 2003, nine published original reports were identified. These were evaluated with regards to the technique, advantages and disadvantages, perioperative and oncological outcomes. Our initial experience, as yet unpublished, is also described. Results: At this writing, all published papers on RRC are based on small number of patients with short-term follow-up. Nevertheless, they have demonstrated the technical feasibility of RRC with encouraging perioperative outcomes. Compared to open radical cystectomy (ORC), RRC appears to be associated with decreased blood loss, hospital stay and analgesic requirement. These advantages are also found with laparoscopic radical cystectomy (LRC) and are a function of the minimally invasive approach. The operating time is longer, markedly so when the bowel work is performed intracorporeally. Conclusions: RRC is in evolution. Technical feasibility has been demonstrated. Initial perioperative outcomes are encouraging. Oncological outcomes are awaited to identify the role of RRC in the management of bladder cancer. Multi-center prospective randomized trials comparing ORC with RRC and LRC are necessary.

Objetivos: En la última década hemos visto un tremendo crecimiento en la implantacion y desarrollo de los robots quirúrgicos. Popularizados por la prostatectomía radical, las técnicas robóticas están siendo, en la actualidad, muy aplicadas en la cistectomía radical. Trataremos aquí de revisar el desarrollo y estado actual de la cistectomía radical robótica (CRR) en la práctica contemporánea de la urología. Métodos: Se ha revisado toda la literatura publicada, entre 1995 y 2007, en la base de datos de la Biblioteca Nacional de Medicina (MEDLINE) utilizando las palabras clave: robótica, asistido por robot, laparoscópica y cistectomía. Desde el primer trabajo en 2003, se han encontrado 9 originales publicados. Se valoraron con respecto a la técnica, ventajas y desventajas perioperatorias y resultados oncológicos. Describimos asimismo nuestra experiencia inicial, aún no publicada. Resultados: En este momento todos los artículos publicados sobre la CRR se basan en un número pequeño de pacientes con seguimientos a corto plazo. No obstante, demuestran la viabilidad de la CRR con resultados perioperatorios esperanzadores. Comparada con la cistectomía radical abierta (CRA), la CRR parece estar asociada con menor pérdida de sangre, estancia hospitalaria y necesidades analgésicas. Estas ventajas se encuentran asimismo en la cistectomía radical laparoscópica (CRL) y son una función del abordaje mínimamente invasivo. El tiempo quirúrgico es mayor, de forma considerable cuando el tiempo intestinal se realiza de manera intracorpórea. Conclusiones: La cistectomía radical robótica está en evolución. La viabilidad técnica ha sido demostrada. Los resultados perioperatorios iniciales son prometedores. Los resultados oncológicos esperan identificar el papel de la misma en el manejo del cáncer de vejiga. Se necesitan ensayos prospectivos y aleatorizados comparando la CRA con la CRR y la CRL.