The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

Abstract

Purpose:We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. Materials and Methods: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. Results: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5±145.1 minutes, and the mean estimated blood loss was 346.8±205.9 ml. The mean time for PLND was 106.7±25.2 minutes in patients with ePLND and 72.1±14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23. 5±12.8 (range, 8-50)

Initial Experience of Robot-Assisted Radical Cystectomy with Total Intracorporeal Urinary Diversion: Comparison with Extracorporeal Method

“…2 We previously reported results from our experience with ECUD. 5,6 Urinary diversion performed using a total intracorporeal method can have additional benefits, including less incisional pain, decreased bowel exposure and desiccation, and the potential for decreased fluid imbalances. 3,9 However, determining whether to create a completely ICUD versus performing the reconstruction extracorporeally is still a controversial and critical issue.…”

“…5,6 At our institute, RARC is usually performed after PLND. In this study, we describe only the surgical technique for total ICUD.…”

Urologic robotic surgery in Korea: Past and present

“…The mean duration of hospital stay was 12 days. Kang et al [ 34 ] presented 21 cases of RALRC, which included 13 cases of ileal conduit urinary diversion and eight cases of orthotopic neobladder. They also tried extended pelvic lymph node dissection.…”

Standardized analysis of complications after robot-assisted radical cystectomy: Korea University Hospital experience

“…Of these patients, a consecutive series of 11 patients underwent RARC and a total ICUD from 2011. The surgical technique used for RARC with PLND including basic positioning and port placement was previously described [ 6 , 7 , 8 ]. The robot-assisted approach was implemented during cystectomy, during bilateral PLND, and for intracorporeal urethrovesical anastomotic stitches in cases of an orthotopic neobladder.…”