Combined robot-assisted simple prostatectomy and laparoscopic nephrectomy: a case series

The indications for robotic surgery in urology continue to expand with the evolution of surgical techniques and technologies. The feasibility of combined robotic/laparoscopic surgery for the treatment of synchronous upper and lower urinary tract malignancies has been previously described. However, to our knowledge, this is the first reported series of robotic-assisted simple prostatectomy (RASP) and robotic/laparoscopic nephrectomies performed in a single operative session.

Case 1 involves an 80-year-old non-Hispanic White man of European descent with a history of low-risk prostate cancer who presented with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), and renal cell carcinoma (RCC). Robotic-assisted partial nephrectomy (RAPN) and RASP were performed sequentially, with modified port placements that allowed reuse of several trocar sites. Case 2 involves a 75-year-old North African man with a history of bilateral polycystic kidneys and stage IV chronic kidney disease who presented with LUTS due to BPH and unilateral RCC. This patient underwent RASP and conventional laparoscopic radical nephrectomy (LRN) in a single operative session. The total operative time was 221 min for Case 1 (94 min for RAPN and 77 min for RASP) and 255 min for Case 2 (104 min for LRN and 95 min for RASP). The estimated blood loss was 100 ml and 80 ml, respectively, with no transfusions required. Case 1 was discharged on post-operative day (POD) 1. Subsequent follow-up demonstrated alleviation of LUTS and no evidence of cancer recurrence. Case 2 was discharged on POD 3, with ongoing oncological surveillance.

These cases demonstrate that combined RAPN or LRN with RASP can be performed safely even in patients with significant comorbidities. The success of these cases can be attributed to meticulous preoperative planning and involvement of a multidisciplinary care team. When feasible, combined surgery may offer benefits such as decreased risks associated with anesthesia and shorter hospitalizations.