Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance

Abstract

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA OBJECTIVE To compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). PATIENTS AND METHODS From November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared. RESULTS The mean EBL and transfusion requirements for standard and daVinci‐assisted cases was 1109 and 479 mL (P = 0.002) and 2.7 and 1.6 units (P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group (P = 0.084). The mean operative duration was 638 and 507 min (P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days (P = 0.52). There was no difference in patient BMI between the groups (P = 0.22). CONCLUSION The daVinci‐assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings.

First case series of robotic radical cystoprostatectomy, bilateral pelvic lymphadenectomy, and urinary diversion with the da Vinci S system

“…Histopathology revealed transitional cell carcinoma in all the patients (pT2a-1, pT2b-3, pT3a-2). The mean number of nodes removed was 12 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). One patient had a node-positive disease.…”

“…However, even with the use of the fourth arm there is still the need for a skilled surgical assistant for suction, retraction, feeding, and retrieval of sutures and clipping of vascular pedicles. The summary of published series (to date) of RRC and urinary diversion is shown in Table 1 [8][9][10][19][20][21][22]. The urinary diversion can be constructed in three ways: (1) completely extracorporeal, (2) completely intracorporeal, and (3) extracorporeal reconstruction followed by intracorporeal urethral anastomosis using the robot after closing the incision (in the case of neobladder).…”

Robotic surgery

“…32 Since then several other authors have published their initial experiences with this procedure. [33][34][35][36] The procedure is safe with acceptable operating times and good shortterm functional and oncological results. [37][38][39][40] In 2008 Elhage et al described their surgical technique and looked at the financial aspect from a British perspective.…”

Roboterassistierte radikale Zystektomie

“…Nach Auswahl der jeweils aktuellsten Publikation konnten 1 Multicenterstudie, 8 konsekutive Fallserien, 1 RCT sowie 5 retrospektive Kohortenvergleiche eingeschlossen werden [6,8,10,12,13,14,15,19,20,21,22,23,24,27].…”

“…Trotzdem ist die Datenlage in Bezug auf einen Vergleich mit der offenen radikalen Zystektomie bislang dürf-tig. Lediglich Untersuchungen, in denen retrospektiv konsekutive RARC-mit ORC-Kohorten verglichen wurden, sowie eine kleinere prospektiv randomisierte Studie eines einzelnen Zentrums sind publiziert [6,20,21,23,24,27].…”