Initial Experiences with Robot-Assisted Laparoscopic Radical Cystectomy

Abstract

PurposeRobot-assisted laparoscopic radical cystectomy (RLRC) is a new option for the treatment of muscle-invasive bladder cancer, and case series for RLRC have been increasing recently. We report our operative technique and initial experiences with RLRC with extracorporeal urinary diversion.Materials and MethodsBetween October 2008 and November 2009, 17 consecutive patients with muscle-invasive bladder cancer underwent RLRC, pelvic lymph node dissection, and extracorporeal urinary diversion. Urinary diversion included 13 ileal conduits and 4 orthotopic neobladders (Studer method). Data were collected prospectively on patient demographics, intraoperative parameters, pathologic staging, and postoperative outcomes.ResultsThe mean patient age was 63.7 years. The mean body mass index was 22.6 kg/m2. No patients had a history of previous abdominal surgery. The mean operative time was 379.1 minutes, including 32.6 minutes for pelvic lymph node dissection, 185.2 minutes for RLRC, and 159.4 minutes for urinary diversion. The mean estimated blood loss was 210.5 ml. The mean hospital stay was 20.7 days and the mean time to oral intake and ambulation was 5.0 and 1.3 days, respectively. There were no major perioperative complications. The pathologic reports showed urothelial cell carcinomas in all cases.ConclusionsOur initial clinical experiences indicate that RLRC with pelvic lymph node dissection and extracorporeal urinary diversion is a safe and feasible procedure with minimal blood loss and rapid recovery. Long-term follow up in a larger patient population is needed to determine the true oncological and functional benefit of this procedure.

Complications and oncologic outcomes following robot-assisted radical cystectomy: What is the real benefit?

“…Patients were reviewed at 4 weeks and assessed by renal ultrasonography (2 weeks poststent removal) and computed tomography scans (3 and 6 months postoperatively, and then at 6-month intervals). Every visit comprised a clinical examination with assessment of hemoglobin, creatinine, chloride, bicarbonate, and urethral washing cytology [ 22 ].…”

“…Our hospital started performing RARC since 2008. We reported our operative techniques and initial experiences regarding RARC in March 2010 [ 22 ]. Between October 2009 and November 2009, 17 consecutive patients underwent RARC (13 ileal conduits, 4 orthotopic neobladders).…”

Systematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy

“…Most of the surgical series were retrospective, single-center studies, with the exception of some prospective studies [8,9,29,32,33,48,62,63,67,69,71,73,77] and some multi-institutional collaboration papers [19,24,26,30,38,39,43,45,72] (LOE 4). Only three of the comparative studies were randomized [78][79][80] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

“…Exceptions included prospective studies [8,22,28,35,36,43,52,59,64,66,81,87] and some multi-institutional retrospective collaboration studies [16,23,25,30,45,48,54,61,68]. Only two of the comparative studies were randomized [74,83] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”