Reoperations following Robot-Assisted Radical Cystectomy: A Decade of Experience

Abstract

Even in experienced hands the long-term complications of robot-assisted radical cystectomy are notable. Of our patients 23% required surgical interventions after the procedure. Our initial experience with robot-assisted management of robot-assisted radical cystectomy complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience.

Evolution of cystectomy care over an 11‐year period in a high‐volume tertiary referral centre

“…In the present study, 42/73 reoperated patients (57.5%) were from the ORC cohort ( P = 0.015). Wound dehiscence (15/73; 20.5%), mechanical bowel obstruction (9/73; 12.3%) and postoperative bleeding (7/73; 9.6%) were the most common causes of surgical re‐intervention, in line with the findings published by Hussein et al . Our overall postoperative mortality rate was in line with the international literature (0–8%) .…”

“…Overall, 44 patients (5.4%) were admitted to the ICU within 3 months of surgery (28 after ORC, 16 after RARC; P = 0.005): most of them (38/44) were admitted only once. During their stay (median [interquartile range] time spent in ICU 4.5 days), 40 patients improved and were discharged, while four died. Pneumonia, sepsis and postoperative bleeding were the most common reasons for admission, accounting for 22.7%, 22.7% and 15.9% of the cases, respectively.…”

“…Radical cystectomy (RC) with pelvic lymph node dissection (PLND), represents the ‘gold standard’ approach to patients with muscle‐invasive and refractory non‐muscle‐invasive bladder cancer (BCa) . Despite centralization of BCa treatment to high‐volume centres , the introduction of enhanced recovery protocols , standardization in surgical technique and widespread adoption of minimally invasive surgery, RC is still considered a major surgical procedure and the risk of severe complications remains high . Hospital readmission after major surgical procedures occurs in approximately one in eight patients, and the rate is even higher after cancer surgery .…”

Robot‐assisted approach to ‘W’‐configuration urinary diversion: a step‐by‐step technique

“…Our present series has its limitations in terms of early experience with short follow‐up with limited numbers and performed by a single experienced robotic surgeon. Our present study supports our stepwise programme of shifting towards an entire robot‐assisted practice, starting with ileal conduits in 2009 and re‐operations in 2015 . Long‐term results of urodynamics, functional and quality‐of‐life studies will help better define the role of the ‘W’ configuration using a robotic interface and its impact.…”

Current status and future perspective of robot‐assisted radical cystectomy for invasive bladder cancer

“…40 Hussein et al retrospectively reviewed patients who underwent surgical interventions for RARC-specific complications between 2005 and 2015. 42 Among 405 patients who underwent RARC by a single surgeon, 92 patients (23%) underwent surgical interventions during an average period of 14 months after RARC. The reoperation rates were 5%, 2% and 16% at 30, 31-90 and >90 days, respectively.…”