Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection. Several studies demonstrated its feasibility and safety, with promising accuracy in nodal staging during robot-assisted radical prostatectomy (RARP) and in recurrence setting during salvage lymph node dissection (sLND) in patients who experience biochemical recurrence (BCR) after primary treatment and have positive PSMA positron emission tomography (PET). Near-infrared PSMA tracers, such as OTL78 and IS-002, have shown potential in intraoperative fluorescence-guided surgery, improving positive surgical margins (PSMs) and LNMs identification. Finally, augmented reality (AR), which integrates preoperative imaging (e.g., multiparametric magnetic resonance imaging [mpMRI] of the prostate and computed tomography [CT]) onto the surgical field, can provide a real-time visualization of anatomical structures through the creation of three-dimensional (3D) models. These technologies may assist surgeons during intraoperative procedures, thus optimizing the balance between oncological control and functional outcomes. However, challenges remain in standardizing these tools and assessing their impact on long-term PCa control. Overall, these advancements represent a paradigm shift toward personalized and precise surgical approaches, emphasizing the integration of innovative strategies to improve outcomes of PCa patients.

This study aimed to assess early outcomes of the single-port (SP) robotic Low Anterior Access (LAA) for all upper urinary tract surgeries. Additionally, it aimed to explore the impact of clinical factors, notably Body Mass Index (BMI), on post-operative outcomes and length of hospital stay. Overall, 76 consecutive patients underwent SP robotic surgery with LAA involving all upper urinary tract pathologies, with data collected prospectively. Baseline characteristics, intra- and post-operative outcomes, pain levels, and opioid use were analyzed. Statistical methods, including logistic regression and locally weighted scatterplot smoothing (LOWESS) analysis, were used to assess same-day discharge (SDD) predictors and the association between BMI and same-day discharge probability. According to the Institutional Review Board (IRB) protocol, only data recorded in our electronic medical record system were included. Ten different procedures were performed with LAA, with no need for conversion to open surgery and complication rates in line with the literature (30-days: 5%, 90-days: 6.6%). Notably, 77.6% of patients were discharged on the same day. A significant association was found between BMI and prolonged hospital stay, particularly in obese patients (BMI ≥ 30 kg/m2). Post-operative pain was generally low (median VAS: 4), with over 70% discharged without opioid prescriptions. The novel LAA is a versatile approach for various upper urinary tract surgeries, even in obese patients. While achieving satisfactory post-operative outcomes, increased BMI correlated with a reduced likelihood of same-day discharge. Further studies, including larger cohorts and multicenter collaborations, are warranted to explore anesthesiologic management and validate these findings.

Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (¹). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (²–⁵). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access.

To evaluate the surgical outcomes and the safety profile of patients treated with thulium fiber laser (TFL) for the ablation of upper tract urothelial cancer (UTUC). Between January 2022 and May 2024, 33 patients underwent URS for UTUC ablation using TFL in a single referral center. Data were collected prospectively and analyzed retrospectively. Baseline characteristics, peri- and post-operative surgical outcomes were reviewed. All procedures were performed by the same dedicated team specializing in endourological treatments of UTUC, with a minimum follow-up of six months. Intraoperative, 30-day and 90-day postoperative complications were collected and classified according to Clavien-Dindo Classification. Residual disease was assessed in patients undergoing second-look ureteroscopy. Median age was 74 (70-83) years and 70% had an ASA score ≥3. Papillary exophytic tumors were most common (24/33), with urothelial carcinoma confirmed in 28 cases, including 20 high-grade UTUCs. Intraoperative complications occurred in four patients, with only one Grade 2 complication. Overall, 76% experienced no postoperative complications, while the 30- and 90-day complication rates were 24% and 21%, respectively, with only one major complication (3%). Residual disease was found in four of 19 patients who underwent second-look URS. Limitations include the lack of a comparison arm and small sample size. This study is the largest series on TFL for UTUC ablation and confirms its safety with low major complication rates and promising oncological outcomes, supporting its inclusion in the laser armamentarium for UTUC management.