Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality?

Abstract

With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars’ positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.

Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome

“…Notably, the average operation time of 177±36 min was distinctly shorter in our case series compared to the literature on combined robotic or laparoscopic prostatectomy and kidney surgery, which showed operation times ranging from 240 min up to 550 min. 8,9,29 In both approaches, no intraoperative complications were observed. 8,9,30 On the other hand, the mean estimated blood loss of 690±529 mL was higher compared to the laparoscopic approaches with a mean blood loss of 350 mL, which could partly be explained by the pneumoperitoneum in robotic or laparoscopic surgery.…”

“…6 Usually, the surgical treatment of synchronous prostate and kidney cancer is performed using a two-stage approach with either open or robotic surgery. 7,8 Combined surgery for simultaneous prostate and kidney cancer has not been established as a standard treatment, but it offers some hypothetical advantages such as reducing the number of hospitalizations, anaesthesia, and postoperative rehabilitations, as well as patient anxiety and cost [9]. There have been several case reports and case series on simultaneous robotic or laparoscopic prostate and kidney surgery, combining robotic prostatectomy with either robotic nephrectomy and unilateral or bilateral partial nephrectomy or laparoscopic and hand assisted nephrectomy or partial nephrectomy with satisfactory results.…”

“…There have been several case reports and case series on simultaneous robotic or laparoscopic prostate and kidney surgery, combining robotic prostatectomy with either robotic nephrectomy and unilateral or bilateral partial nephrectomy or laparoscopic and hand assisted nephrectomy or partial nephrectomy with satisfactory results. [7][8][9][10][11][12] To the best of our knowledge, no study has investigated the feasibility and safety of a combined open surgical approach for synchronous prostate and kidney cancer. Therefore, the aim of this study is to assess the feasibility, safety and 12-month outcome of a combined open surgical approach to close the gap in existing research.…”

Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background

“…A suspected malignant renal tumor should be removed with clear surgical margins [ 2 , 3 ]. In the case of cT1 renal neoplasm, partial nephrectomy or enucleation is recommended [ 4 , 5 ] in order to preserve renal function [ 3 ] for eventual adjuvant therapy. Therefore, a combined surgical procedure was indicated to remove both the renal and adrenal mass in December 2017.…”

New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique

“…The main disadvantages are the absence of tactile feedback and the high costs. However, the robotic approach allows you to reproduce the same steps as "open" surgery, but with the benefits of minimally invasive surgery, overcoming the limits of laparoscopy: simplifying the learning curve and reducing the surgeon's physical discomfort [7]. All this has led to an increasingly widespread diffusion of robotic surgery, which finds its main indication in RP.…”