Ettore Mearini

Luigi Schips

Philippe Sèbe

Frontiers in Surgery

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TYPE EditorialPUBLISHED 21 November 2023| DOI 10.3389/fsurg.2023.1260951EDITED BYRichard Naspro,San Matteo Hospital Foundation (IRCCS), ItalyREVIEWED BYVincenzo Li Marzi,Careggi Hospital, ItalyMarco Paciotti,Humanitas Research Hospital, Italy*CORRESPONDENCEEttore Meariniettore.mearini@unipg.itRECEIVED 18 July 2023ACCEPTED 01 November 2023PUBLISHED 21 November 2023CITATIONMearini E, Schips L and Sèbe P (2023) Editorial:History, advantages, complications, and limitsof minimally invasive urologic pelvic surgery.Front. Surg. 10:1260951.doi: 10.3389/fsurg.2023.1260951COPYRIGHT© 2023 Mearini, Schips and Sèbe. This is anopen-access article distributed under the termsof the Creative Commons Attribution License(CC BY). The use, distribution or reproduction inother forums is permitted, provided the originalauthor(s) and the copyright owner(s) arecredited and that the original publication in thisjournal is cited, in accordance with acceptedacademic practice. No use, distribution orreproduction is permitted which does notcomply with these terms.Frontiers in SurgeryEditorial: History, advantages,complications, and limits ofminimally invasive urologic pelvicsurgeryEttore Mearini1*, Luigi Schips2 and Philippe Sèbe21Department of Medicine, Urology Clinic, University of Perugia, Perugia, Italy, 2Department of Medical,Oral and Biotechnological Sciences, School of Medicine and Health Sciences, Urology, G. D’AnnunzioUniversity of Chieti-Pescara, Chieti, ItalyKEYWORDSminimally invasive surgeries (MIS), robotic surgery, complications, surgical limits,laparoscopy, complications classification systemEditorial on the Research TopicHistory, advantages, complications, and limits of minimally invasiveurologic pelvic surgerySince its introduction to the medical field, minimally invasive surgery (MIS) has been a topicof debate due to concerns about safety and efficacy across various specialties.The first laparoscopic series of cases was described by Jacobaeus in 1910. However, it wasonly in 1924 that the use of carbon dioxide instead of air was proposed by Zollikofer.Initially, laparoscopy was confined to the gynecological field, but it was later adopted byurology in 1976, when Cortesi used it for undescended testis. However, early experienceswere fraught with difficulties, which included long operative times, surgical failures, and ahigh rate of complications (1, 2). In laparoscopic procedures, many of the latter were dueto surgeons being unfamiliar with the technique (2, 3). However, by the 1990s, moresurgeons had completed the learning curve, which led to a wider adoption of laparoscopyfor many procedures (4, 5). Its advantages include a magnification of the surgical field,faster postoperative recovery, and better cosmetic results (5). During the “golden age” oflaparoscopy, the development of the first robotic systems in medicine began. Thenecessity for remote surgeries due to global wars and the dream of men on Mars led tothe development of the first master-slave robotic system in the 1990s (6). The evolutioncontinued with the creation of an endoscopic camera manipulator that could becontrolled by the surgeon’s voice commands. This marked the first development of asystem capable of replicating the movements of the surgeon’s arm, called the ZEUSsystem by Computer Motion. The latter merged with Intuitive Surgical®, leading to thebirth of the widely known DaVinci® robotic system (6). Further development resulted inthe creation of additional robotic systems with unique characteristics, as highlighted byDong et al. in their prospective study of retroperitoneal partial adrenalectomy (7). Theserobotic systems have comparable outcomes to the DaVinci® robotic system.The widespread adoption of robotic systems in surgery can be attributed to the experiencegained by many surgeons with laparoscopy and the additional benefits brought by thistechnique. These benefits include improved precision of movements, better surgicaldissection, and enhanced bleeding control. The advantages of MIS have transformed the way01 frontiersin.orgMearini et al. 10.3389/fsurg.2023.1260951surgical techniques are learned. The magnification of the surgicalfield has led to a redefinition of surgical boundaries, resulting in asmaller visual space and limited control of surrounding structures.The magnification and precision of movements have shifted thesurgical focus from a tactile to a visual approach, leading to longeroperative times but also reducing surgical and functionalcomplications. All of the above, along with the implementation ofprotocols for enhanced recovery after surgery, has led to a betterunderstanding of this type of high-cost surgery, as emphasized byLei et al. in their contribution to this Research Topic (8).Unfortunately, minimally invasive surgery is not alwaysapplicable, with its major limitations becoming apparent in cases ofadvanced disease (9–12). In such situations, complications can ariseduring surgery, making it even more important for surgeons andpatients to make informed decisions together. The Clavien-Dindoclassification system has standardized the reporting of complicationssince its initial implementation and has been updated with thelatest EAU intraoperative adverse incident classification (13).Standardizing surgical complications and functional sequelae helpsto reduce their impact, improve knowledge, and enhance treatmentoutcomes. However, the classification systems used in research lacka shared management approach to standardize results and lackbasic tools to help patients better understand complications. Theclassification system enables healthcare providers to explain thepossible complications associated with surgeries such as robot-assisted radical prostatectomy in advanced disease or cystectomy, asdescribed by Cochetti et al. and Paladini et al. The Clavien-Dindoclassification aims to categorize possible complications for allsurgical interventions, but specific complications must be identifiedfor each procedure (14–17).The limits and complications of MIS compared to the opensurgical technique were widely discussed when it was firstintroduced. However, after several years, MIS gained wideradoption, with many highly experienced open surgeonsperforming it. With the emergence of new technologies andtechnical skills in the urological field, many new urologists nowhave extensive MIS experience but limited experience with opensurgery. Despite more than 20 years of MIS, its limitations,complications, and relative management techniques are stillFrontiers in Surgery 02evolving. Therefore, it is essential to investigate the issue oflimitations and complications to prevent them and makeinformed decisions about their management.This research topic emphasizes the importance of applyingcomplication classification systems to report unexpected events toimprove knowledge and evidence of urological complications,with the ultimate goal of developing guidelines for complicationmanagement.Author contributionsEM: Conceptualization, Supervision, Validation, Writing –original draft, Writing – review & editing. PS: Conceptualization,Visualization, Writing – review & editing. LS: Conceptualization,Supervision, Visualization, Writing – review & editing.FundingThe author(s) declare that no financial support was received forthe research, authorship, and/or publication of this article.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteedor endorsed by the publisher.References1. Ozkara H, Watson LR. Laparoscopic surgery in urology. Int Urol Nephrol. (1992)24(5):461–4. doi: 10.1007/BF025501112. Crist DW, Gadacz TR. Complications of laparoscopic surgery. Surg Clin NorthAm. 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Cochetti G, Del Zingaro M, Ciarletti S, Paladini A, Felici G, Stivalini D, et al. Newevolution of robotic radical prostatectomy: a single center experience with PERUSIAtechnique. Appl Sci. (2021) 11(4):1513. doi: 10.3390/app1104151310. Marchioni M, Primiceri G, Delli Pizzi A, Basilico R, Berardinelli F,Mincuzzi E, et al. Could bladder multiparametric MRI be introduced inroutine clinical practice? Role of the new VI-RADS score: results from aprospective study. Clin Genitourin Cancer. (2020) 18(5):409–415.e1. doi: 10.1016/j.clgc.2020.03.00211. Marchioni M, Bandini M, Pompe RS, Martel T, Tian Z, Shariat SF, et al.The impact of lymph node dissection and positive lymph nodes on cancer-specific mortality in contemporary pT2-3 non-metastatic renal cell carcinomatreated with radical nephrectomy. BJU Int. (2018) 121(3):383–92. doi: 10.1111/bju.1402412. Pizzi A D, Mastrodicasa D, Taraschi A, Civitareale N, Mincuzzi E, Censi S, et al.Conspicuity and muscle-invasiveness assessment for bladder cancer using VI-RADS: afrontiersin.orgMearini et al. 10.3389/fsurg.2023.1260951multi-reader, contrast-free MRI study to determine optimal b-values for diffusion-weighted imaging. Abdom Radiol (NY). (2022) 47(5):1862–72. doi: 10.1007/s00261-022-03490-913. Biyani CS, Pecanka J, Rouprêt M, Jensen JB, Mitropoulos D. Intraoperativeadverse incident classification (EAUiaiC) by the European association of urology adhoc complications guidelines panel. Eur Urol. (2020) 77(5):601–10. doi: 10.1016/j.eururo.2019.11.01514. Cochetti G, Paladini A, Del Zingaro M, Ciarletti S, Pastore F, Massa G,et al. Robot-assisted radical cystectomy with intracorporeal reconstructionof urinary diversion by mechanical stapler: prospective evaluation of early and latecomplications. Front Surg. (2023) 10:1157684. doi: 10.3389/fsurg.2023.1157684Frontiers in Surgery 0315. 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Editorial: History, advantages, complications, and limits of minimally invasive urologic pelvic surgery

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Editorial: History, advantages, complications, and limits of minimally invasive urologic pelvic surgery

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