{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:59:42Z","timestamp":1785301182312,"version":"3.55.0"},"reference-count":49,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Prostate cancer is one of the most common non-skin solid malignancies among male solid organ transplant recipients (SOTRs), in whom radical prostatectomy is technically demanding. We report the first use of indocyanine green (ICG) fluorescence for simultaneous transplanted-ureter identification and renal graft vascular mapping during robot-assisted radical prostatectomy (RARP), and the first use of the CMR Versius\u00ae platform in a SOTR. Methods: Retrospective case series of four consecutive male SOTRs (two renal [RTRs], two hepatic) undergoing RARP. In both RTRs, a dual-route ICG protocol was used on the da Vinci Xi with Firefly\u00ae imaging: pre-docking intraureteral ICG via a ureteral catheter for ureter identification, plus an intravenous ICG bolus for graft vascular mapping and cortical perfusion. One hepatic recipient was operated with the CMR Versius\u00ae system using an infra-umbilical port configuration to avoid the chevron transplant scar. Results: All four procedures were completed robotically without conversion. Median operative time was 176 min and median estimated blood loss 350 mL. Surgical margins were negative (R0) in all four; final pathology was pT3aN0 in three and pT2N0 in one, although in the renal recipients nodal staging reflected a contralateral-only dissection. PSA was undetectable at three months in all patients. One hepatic recipient later developed biochemical recurrence, managed with salvage radiotherapy and androgen deprivation therapy, with subsequent undetectable PSA. One hepatic recipient had a Clavien\u2013Dindo IIIa complication. No graft dysfunction occurred. Conclusions: ICG-guided RARP and the CMR Versius\u00ae platform appear technically feasible in carefully selected solid organ transplant recipients treated at an experienced multidisciplinary centre, with no graft-related complications observed in this small initial series. These preliminary findings require validation in larger, multicenter studies before general safety and oncological efficacy can be established.<\/jats:p>","DOI":"10.3390\/cancers18152408","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:49:27Z","timestamp":1785131367000},"page":"2408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robot-Assisted Radical Prostatectomy in Solid Organ Transplant Recipients: Initial Experience and Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Wojciech","family":"Po\u0142om","sequence":"first","affiliation":[{"name":"Department of Urology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9720-4701","authenticated-orcid":false,"given":"S\u0142awomir","family":"Lizakowski","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-9037","authenticated-orcid":false,"given":"Katarzyna","family":"Skrobisz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-685X","authenticated-orcid":false,"given":"Marcin","family":"Matuszewski","sequence":"additional","affiliation":[{"name":"Department of Urology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/bju.14018","article-title":"Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review","volume":"121","author":"Marra","year":"2018","journal-title":"BJU Int."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Marra, G., Soeterik, T., Dariane, C., Timsit, M.O., Branchereau, J., Mesnard, B., Tilki, D., Olsburgh, J., Kulkarni, M., and Kasivisvanathan, V. (2022). Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort. Cancers, 15.","DOI":"10.3390\/cancers15010189"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1111\/j.1600-6143.2008.02430.x","article-title":"The Effect of Sirolimus on Prostate-Specific Antigen (PSA) Levels in Male Renal Transplant Recipients Without Prostate Cancer","volume":"8","author":"Chamie","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.eururo.2022.05.024","article-title":"Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series","volume":"82","author":"Marra","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Piana, A., Pecoraro, A., Sidoti, F., Checcucci, E., D\u00f6nmez, M.\u0130., Prudhomme, T., Ba\u00f1uelos Marco, B., L\u00f3pez Abad, A., Campi, R., and Boissier, R. (2023). Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216754"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1590\/s1677-5538.ibju.2018.0308","article-title":"Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients: Surgical, Oncological and Functional Outcomes of Two Different Robotic Approaches","volume":"45","author":"Mistretta","year":"2019","journal-title":"Int. Braz. J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sirisopana, K., Jenjitranant, P., Sangkum, P., Kijvikai, K., Pacharatakul, S., Leenanupunth, C., Kochakarn, W., and Kongchareonsombat, W. (2021). Radical Prostatectomy Outcomes in Renal Transplant Recipients: A Retrospective Case Series of Thai Patients. BMC Urol., 21.","DOI":"10.1186\/s12894-021-00862-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.eururo.2014.08.057","article-title":"Use of Indocyanine Green During Robot-Assisted Ureteral Reconstructions","volume":"67","author":"Lee","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_9","first-page":"111","article-title":"Intraureteral and Intravenous Indocyanine Green to Facilitate Robotic Partial Nephroureterectomy in a Patient with Complete Ureteral Triplication","volume":"17","author":"Lee","year":"2015","journal-title":"Rev. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1111\/codi.15407","article-title":"Intraureteral Indocyanine Green Augments Ureteral Identification and Avoidance During Complex Robotic-Assisted Colorectal Surgery","volume":"23","author":"White","year":"2021","journal-title":"Colorectal Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"436.e1","DOI":"10.1016\/j.ajog.2014.05.017","article-title":"Indocyanine Green for Intraoperative Localization of Ureter","volume":"211","author":"Siddighi","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kim, J., Jang, Y., Choi, S.H., Jung, Y.W., Kim, M.L., Yun, B.S., Seong, S.J., and Jun, H.S. (2023). Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery. J. Pers. Med., 13.","DOI":"10.3390\/jpm13091345"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/SLA.0000000000004529","article-title":"Quantitative Assessment of Intraoperative Laser Fluorescence Angiography With Indocyanine Green Predicts Early Graft Function After Kidney Transplantation","volume":"276","author":"Gerken","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","first-page":"2127","article-title":"Methodological Quality of Case Series Studies: An Introduction to the JBI Critical Appraisal Tool","volume":"18","author":"Munn","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer\u20142024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_17","first-page":"30","article-title":"Initial Experience of the Versius Robotic System in Robot-Assisted Radical Prostatectomy: A Study of 58 Cases","volume":"77","author":"Matuszewski","year":"2024","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.eururo.2011.10.044","article-title":"Updated Nomogram Predicting Lymph Node Invasion in Patients with Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection: The Essential Importance of Percentage of Positive Cores","volume":"61","author":"Briganti","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1089\/end.2018.0394","article-title":"Safety and Clinical Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A Systematic Review","volume":"32","author":"Zeng","year":"2018","journal-title":"J. Endourol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"185","DOI":"10.23736\/S0393-2249.19.03334-4","article-title":"Robot Assisted Laparoscopic Prostatectomy in Liver Transplant Recipient","volume":"71","author":"Lim","year":"2019","journal-title":"Minerva Urol. Nefrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1089\/end.2008.0280","article-title":"Robot-Assisted Laparoscopic Radical Prostatectomy in the Renal Allograft Transplant Recipient","volume":"22","author":"Jhaveri","year":"2008","journal-title":"J. Endourol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1089\/cren.2020.0146","article-title":"Robot-Assisted Radical Prostatectomy in a Second Kidney Transplant Recipient","volume":"6","author":"Minami","year":"2020","journal-title":"J. Endourol. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.euros.2024.07.111","article-title":"Radical Prostatectomy in Kidney Transplant Recipients\u2014A Multicenter Experience","volume":"67","author":"Schmidt","year":"2024","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"599.e15","DOI":"10.1016\/j.urolonc.2019.12.017","article-title":"Morbidity, Perioperative Outcomes and Complications of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A French Multicentre Study","volume":"38","author":"Felber","year":"2020","journal-title":"Urol. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.transproceed.2020.01.032","article-title":"Oncological and Postoperative Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Transplant Recipients: A Multicenter and Comparative Study","volume":"Volume 52","author":"Boutin","year":"2020","journal-title":"Transplantation Proceedings"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2021.00045","DOI":"10.4293\/JSLS.2021.00045","article-title":"Oncological and Functional Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Recipients","volume":"25","author":"Shahait","year":"2021","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/j.urology.2012.08.048","article-title":"Multicenter Experience with Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients","volume":"80","author":"Polcari","year":"2012","journal-title":"Urology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.transproceed.2012.01.120","article-title":"Applicability of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Allograft Recipients","volume":"Volume 44","author":"Wagener","year":"2012","journal-title":"Transplantation Proceedings"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E490","DOI":"10.5489\/cuaj.2319","article-title":"Technical Feasibility of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Transplant Recipients: Results of a Series of 12 Consecutive Cases","volume":"9","author":"Lecornet","year":"2015","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1159\/000446323","article-title":"Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients. Our Clinical Experience and a Systematic Review","volume":"97","author":"Sierra","year":"2016","journal-title":"Urol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1089\/end.2011.0038","article-title":"Robot-Assisted Radical Prostatectomy in Patients with Previous Renal Transplantation","volume":"25","author":"Smith","year":"2011","journal-title":"J. Endourol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3130","DOI":"10.1016\/j.transproceed.2016.03.035","article-title":"Retzius Space Preservation Technique for Robotic-Assisted Laparoscopic Radical Prostatectomy in a Kidney Transplant Patient: First Case in Thailand and Our First Experience","volume":"48","author":"Jenjitranant","year":"2016","journal-title":"Transplant. Proc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"314","DOI":"10.4293\/108680812X13427982376626","article-title":"Modifications to Facilitate Extraperitoneal Robot-Assisted Radical Prostatectomy Post Kidney Transplant","volume":"16","author":"Ghazi","year":"2012","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/bju.16737","article-title":"Retzius-Sparing Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients","volume":"136","author":"Leow","year":"2025","journal-title":"BJU Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e70128","DOI":"10.1002\/bco2.70128","article-title":"Robotic Radical Prostatectomy in Kidney Transplant Recipients: A Propensity-Matched Cohort Study","volume":"6","author":"Slota","year":"2025","journal-title":"BJUI Compass"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.prnil.2025.11.004","article-title":"Comparative Study of Open Versus Robotic Radical Prostatectomy in Renal Transplant Recipients and Review of the Literature","volume":"14","author":"Waeckel","year":"2026","journal-title":"Prostate Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.transproceed.2016.01.036","article-title":"Robot-Assisted Radical Prostatectomy for Localized Prostate Cancer in Asian Renal Transplant Recipients","volume":"48","author":"Iizuka","year":"2016","journal-title":"Transplant. Proc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1186\/s13256-025-05627-y","article-title":"First Robot-Assisted Radical Prostatectomy Using Hugo Robotic-Assisted Surgery System in a Post-Kidney Transplant Patient: A Case Report","volume":"19","author":"Fukuda","year":"2025","journal-title":"J. Med. Case Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3978","DOI":"10.1016\/j.transproceed.2018.09.015","article-title":"Robot-Assisted Radical Prostatectomy in a Post-Kidney Transplant Patient: An Initial Case Report in China","volume":"50","author":"Fang","year":"2018","journal-title":"Transplant. Proc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1016\/j.transproceed.2018.03.029","article-title":"Radical Prostatectomy for Localized Prostate Cancer in Renal Transplant Recipients: 13 Cases Studied at a Single Center","volume":"50","author":"Iwamoto","year":"2018","journal-title":"Transplant. Proc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.transproceed.2021.08.063","article-title":"Effectiveness of Retzius-Sparing Robot-Assisted Radical Prostatectomy in a Renal Transplant Recipient: A Case Report","volume":"54","author":"Kobari","year":"2022","journal-title":"Transplant. Proc."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hanusz, K., Doma\u0144ski, P., Strojec, K., Zapa\u0142a, P., Zapa\u0142a, \u0141., and Radziszewski, P. (2023). Prostate Cancer in Transplant Receivers\u2014A Narrative Review on Oncological Outcomes. Biomedicines, 11.","DOI":"10.3390\/biomedicines11112941"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/bco2.276","article-title":"The Role of Localised Prostate Cancer Treatment in Renal Transplant Patients: A Systematic Review","volume":"4","author":"Dat","year":"2023","journal-title":"BJUI Compass"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.21037\/tau-21-160","article-title":"Intraoperative Assessment of Ureter Perfusion After Revascularization of Transplanted Kidneys Using Intravenous Indocyanine Green Fluorescence Imaging","volume":"10","author":"Kanammit","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"79","DOI":"10.23736\/S0393-2249.18.03278-2","article-title":"Intraoperative Assessment of Ureteral and Graft Reperfusion During Robotic Kidney Transplantation with Indocyanine Green Fluorescence Videography","volume":"71","author":"Vignolini","year":"2019","journal-title":"Minerva Urol. Nefrol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.euros.2022.11.019","article-title":"Robot-Assisted Radical Prostatectomy with the Versius Robotic Surgical System: First Description of a Clinical Case","volume":"48","author":"Rocco","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Cwalinski, T., Polom, W., Marano, L., Roviello, G., D\u2019Angelo, A., Cwalina, N., Matuszewski, M., Roviello, F., Jaskiewicz, J., and Polom, K. (2020). Methylene Blue\u2014Current Knowledge, Fluorescent Properties, and Its Future Use. J. Clin. Med., 9.","DOI":"10.3390\/jcm9113538"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Polom, W., Migaczewski, M., Skokowski, J., Swierblewski, M., Cwalinski, T., Kalinowski, L., Pedziwiatr, M., Matuszewski, M., and Polom, K. (2022). Multispectral Imaging Using Fluorescent Properties of Indocyanine Green and Methylene Blue in Colorectal Surgery\u2014Initial Experience. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020368"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/15\/2408\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:10:58Z","timestamp":1785298258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/15\/2408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":49,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["cancers18152408"],"URL":"https:\/\/doi.org\/10.3390\/cancers18152408","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]}}}