Victor Enrique Corona-Montes

By Victor Enrique Corona-Montes, Eduardo Gonzalez-Cuenca and Marcos Tobias-Machado

The objective of the following chapter is to describe thoroughly the surgical technique for a robotic-assisted inguinal lymphadenectomy for penile cancer, and the surgery has been through modifications from its creation to “the Robotic Era.” Penile cancer is a rare neoplasm, with an estimated 1570 cases in the United States. The spread is predictable to the inguinal lymph nodes, where 1–2% of patients will present distant metastases. The first draining lymph area is found in the inguinal region and the secondary spread in the pelvic region, main reason for the inguinal part of the treatment of penile cancer under different indications. Radical resection of inguinal metastases of penile cancer is the standard treatment for this technique, which has been adapted to become a minimally invasive surgery compared to an open inguinal lymphadenectomy, which entails a high incidence of morbidity that stands at 50–90%. A robotic-assisted inguinal lymphadenectomy, despite its high cost, is a feasible technique when carried out in specialized centers that can reduce morbidity rates and offer good oncological results, less blood loss, and shorter hospital stay.

Part of the book: Medical Robotics

By Víctor Enrique Corona-Montes, Eduardo Gonzalez-Cuenca, Laurent López, Juan Eduardo Sánchez-Núñez and Richard Gaston

The purpose of this chapter is to provide a step-by-step description of the robot-assisted radical cystectomy with an intra-corporeal neo-bladder technique and a recent review of its outcomes. The procedure is also known as anterior pelvic exenteration or cysto-prostatectomy in the case of female or male respectively. Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer, but there are also several surgical indications for non-muscle-invasive bladder cancer. In the past years, minimally invasive surgery and the da Vinci system technology have played a major role in this procedure, with description of brand-new techniques and specific approaches for the creation of a continent urinary reservoir. The following chapter provides a detailed description of the robot-assisted radical cystectomy (RARC) with Y-shaped intra-corporeal bladder as well as a literary review of distinct perioperative, functional and oncological outcomes from the available RARC randomized controlled trials. Despite its high cost and complexity, the intra-corporeal technique has become widely popular around the world and is used more frequently each time. The described data in this chapter, demonstrates that morbidity can be reduced whilst simultaneously offer non-inferior oncological results and less intraoperative blood loss in contrast to the open RC approach.

Part of the book: Modern Approach to Diagnosis and Treatment of Bladder Cancer

By Victor Enrique Corona-Montes, Vanessa Júarez-Cataneo and Juan Eduardo Sánchez-Núñez

Current technology has improved the modalities of intra-corporeal lithotripsy, including: ultrasound and ballistic, combined with different laser energies useful in the most important procedures for resolving urinary system stones. Nowadays, the amount of lasers and their availability has grown considerably, lasers like Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) and Thulium Fiber Laser (TFL) are the most effective and safest alternatives for lithotripsy in several types of endo urological strategies for lithotripsy. The selection of appropriate laser energy is crucial to optimize the usefulness in the management of urinary tract stones and it depends on the clinical indications validated for the International Urolithiasis Alliance based in technology but also in principles of management from the reported outcomes based in the expertise of several endo urological surgeons. Both, Ho:YAG laser and TFL are effective systems of fragmentation in retrograde intrarenal surgery (RIRS) and percutaneous nephrolitotomy (PNL), even in the miniaturized percutaneous tracts enhanced with suction. Comparative with other types of lithotripsy, they have the same stone-free rates, low complication indexes, and optimal surgical operative times. Urologists must be familiar of with the properties of each laser to get the best surgical outcomes for the benefits of their patients. The present chapter will describe the clinical indications and the adequate use of laser fibers.

Part of the book: Lithotripsy