A Comparison of Postoperative Complications in Open Versus Robotic Cystectomy

Ng, Casey K.; Kauffman, Eric; Lee, Ming-Ming; Otto, Brandon; Portnoff, Alyse D.; Lee, Ray-Kuang; Schwartz, Michael; Scherr, Douglas

doi:10.1016/s0022-5347(09)60363-3

Cited by 57 publications

(113 citation statements)

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“…In our study, a mean number of 15 lymph nodes were removed and two patients (2.1%) had positive surgical margins. In a recent comparison of open and robotic cystectomy by Ng et al, the robotic surgery was associated with decreased blood loss, equal mean operative time, and an equal positive surgical margin rate and lymph node yield (7.2% and 17.9 nodes, respectively) (15). Haber and Gill reported a 5% positive surgical margin rate, a mean lymph node yield of 14 nodes and 92% 5-year cancer specific survival in 37 patients undergoing laparoscopic radical cystectomy (16).…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Treiyer¹,

Saar²,

Bütow³

et al. 2012

Int. braz j urol.

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InTRODUcTIOnRobotic-assisted laparoscopic radical cystectomy has become a surgical option for patients with bladder cancer, providing the benefi ts of minimal invasive surgery with lower blood loss, early return of bowel function and more rapid patient recovery, while apparently maintaining functional and oncological outcomes (1-6). The surgical and perioperative outcomes of initial reports appear to be comparable to the open approach. However, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical and oncological method for patients with bladder cancer. We report our initial experience with robotic assisted laparoscopic radical cystectomy, evaluating the perioperative and pathological outcomes of this procedure.Purpose: Our fi rst 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. Materials and Methods: Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. Results: Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min.) and mean blood loss was 294 mL (range: 50-2000 mL). In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classifi ed as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1%). Mean days to fl atus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11% major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. Conclusions: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes. Robotic

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Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Treiyer¹,

Saar²,

Bütow³

et al. 2012

Int. braz j urol.

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“…Likewise, surgical margins were negative in all patients in both approaches . The Weill Cornell Medical College study, having larger numbers of patients similarly did not find significant differences concerning these two parameters between the two approaches (Ng et al, 2010). Mean lymph node yield was 15.7 in the open surgical approach and was 17.9 in the robotic approach (p>0.05).…”

Section: Comparison Of Oncologic Parametersmentioning

confidence: 84%

“…Mean lymph node yield was 21.3 (range, 8-38) and 24.8.9.2 in our initial series of 12 (Akbulut et al, 2011) and 27 cases (unpublihsed data), respectively. Positive surgical margin rates were reported as 6.8%, 0%, 7.2% and 2% in 513, 83, 100 and 50 robotic cystectomy patients (Hellenthal et al, 2010;Pruthi et al, 2010;Ng et al, 2010;Shamim Khan et al, 2010). In our initial series of 12 patients, positive surgical margin rate was 0% (Akbulut et al, 2011).…”

Section: Surgical Oncologic Safety Of Robotic Approach (Lymph Node Yimentioning

confidence: 99%

“…Menon et al suggested that robotic approach combines the oncological principles of open surgery with technical advantages of the surgical robot which allows a precise, gentle, quick and safe surgery during performing radical cystectomy for bladder cancer (Menon et al, 2003). Therefore, following the introduction of da Vinci-S 4-arm surgical robot (Intuitive Surgical, Sunnyvale, California) many centers have started to publish their experiences with the use of a surgical robot in performing these complex surgical procedures (Akbulut et al, 2011;Rehman et al, 2011;Kauffman et al, 2011;Hellenthal et al, 2010;Kasraeian et al, 2010;Pruthi et al, 2010;Schumacher et al, 2009 (Ng et al, 2010). Complications were classified due to modified Clavien system.…”

Section: Why To Use a Surgical Robot?mentioning

confidence: 99%

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Robotic-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Urinary Diversion (Studer Pouch or Ileal Conduit) for Bladder Cancer

Canda¹,

Atmaca²,

Balbay³

2012

Bladder Cancer - From Basic Science to Robotic Surgery

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“…Ng et al performed a prospective comparison of complications in 187 consecutive patients who underwent radical cystectomy with either ORC or RARC found that the RARC group experienced significantly fewer total complications and major complications at 30 and 90 days [26]. There is only one published randomized control trial of RARC versus ORC, but it was designed as a non-inferiority study regarding lymphadenectomy and nodes retrieval.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

Rao

Stegemann

Rehman

et al. 2012

Indian J Surg Oncol

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Robot-assisted radical cystectomy (RARC) for bladder cancer is increasingly becoming popular in specialist centres around the world. RARC has the advantage of being minimally invasive and also the dexterity of the instruments allow reconstruction such as ileal conduit urinary diversion or neobladder formation. Starting from the initial series demonstrating the feasibility of RARC and extended pelvic lymph node dissection, we now have mature series demonstrating equal oncological and functional outcomes in the medium term follow-up. In addition, literature suggests decreased hospital stay, less blood loss equating to less blood transfusion and a trend towards decreased complications as well. In the near future we would anticipate further refinement and reduced operating times with increased benefits for the patient undergoing RARC.

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A Comparison of Postoperative Complications in Open Versus Robotic Cystectomy

Cited by 57 publications

References 0 publications

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Robotic-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Urinary Diversion (Studer Pouch or Ileal Conduit) for Bladder Cancer

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

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