prospectively in a standard fashion as part of a quality assurance programme. Nine patients were excluded (three had unresectable disease and six underwent palliative cystectomy) and the remainder were divided into five groups. Data included demographics, operative variables, complications and pathological outcomes. Evidence of the LNY curve was examined using nonlinear regression to compare the number of LNs obtained. RESULTSThe mean (range) patient age was 67 (36-90) years and the mean body mass index (BMI) was 27 (17-45) kg/m 2 . The mean operative duration for the robot-assisted pelvic LND was 44 (19-85) min. There was one postoperative complication that required exploration for vascular injury. The mean number of LNs retrieved was 18 (6-43). The mean LNY for each of the five groups was 13, 16, 21, 19 and 23, respectively, and neither BMI nor previous major abdominal surgery affected LNY. CONCLUSIONRobot-assisted RC with pelvic LND was performed safely. LNY was oncologically acceptable and increased with experience.

The authors found that the learning curve for robotassisted radical cystectomy is constantly evolving to improve oncologic outcomes.

Cold incision of the DVC before suture ligation reduces the rate of apical margin involvement during robot-assisted radical prostatectomy.

OBJECTIVE To prospectively determine the effect of robot‐assisted radical cystectomy (RARC) on quality of life (QoL) after surgery. PATIENTS AND METHODS In all, 34 patients who had RARC for bladder cancer between January 2006 and December 2007 at one institution were prospectively enrolled in a study of QoL. All patients had RARC with extracorporeal urinary diversion by one surgeon. As part of the routine follow‐up, QoL was assessed at intervals. Functional Assessment of Cancer Therapy‐Bladder (FACT‐BL) questionnaires were administered before and then over a 6‐month period after RARC. Patients undergoing chemotherapy were not excluded. Follow‐up FACT‐BL and individual domain scores for physical, social, emotional and functional well‐being were compared with those obtained before RARC. RESULTS The mean age of all patients was 65 years, 88% were men, and 13 (38%) had adjuvant chemotherapy. The mean time after RARC for the 1‐, 3‐ and 6‐month assessments was 29, 90 and 193 days, respectively; 19 patients completed three follow‐up questionnaires. Initially, there were significant decreases in the physical and functional domains, with improvements in the emotional domain (P < 0.001). Total FACT‐General and FACT‐BL scores decreased in the initial period after RARC and then progressively improved. There was no statistically significant difference in total scores at 3 months after surgery; at the 6‐month follow‐up the total FACT‐BL scores exceeded those before RARC (P = 0.048). CONCLUSIONS QoL appears to return promptly to, or exceed, baseline levels by 6 months after RARC. The improvement in the short term might allow for more contented patients and quicker initiation of adjuvant chemotherapy.

OBJECTIVE To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot‐assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality. PATIENTS AND METHODS From 2005 to 2007, 66 consecutive patients had RARC at Roswell Park Cancer Institute. Patient demographics, preoperative risk factors and complications up to 3 months after RARC were reviewed from a prospective quality‐assurance database. Patients were stratified into high‐ and low risk groups based on age, previous abdominal surgery, chronic obstructive pulmonary disease (COPD), body mass index (BMI), Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiologists (ASA) score. RESULTS Age, previous abdominal surgery, COPD, BMI, RCRI score and ASA score did not significantly influence complications during or up to 3 months following RARC (P > 0.05). Advanced age was associated with a higher RCRI score (P = 0.014) and an increased likelihood of admission to the Intensive Care Unit (P = 0.007). A higher ASA score was associated with an increased overall hospital stay (P = 0.039). Previous abdominal surgery was associated with more frequent unscheduled postoperative clinic visits (P = 0.014). Operative duration did not significantly influence complication rates (P > 0.05). Fifteen of 62 patients (24%) had a major complication, while 15 (24%) had minor complications within 3 months of surgery. The reoperation rate was 11% and the overall mortality rate was 1.6%. CONCLUSIONS RARC appears to be well tolerated, independent of comorbid risk factors such as age, BMI, RCRI and ASA score.