Robotic-assisted Laparoscopic Radical Cystectomy with Extracorporeal Urinary Diversion: Initial Experience

Murphy, Declan; Challacombe, Benjamin; Elhage, Oussama; O’Brien, Tim; Rimington, Peter; Khan, Mohammad Shamim; Dasgupta, Prokar

doi:10.1016/j.eururo.2008.04.011

Cited by 155 publications

(91 citation statements)

References 26 publications

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“…With regards to perioperative outcomes a mean robotic operating time of 265 min is comparable with the results published in other studies (1)(2)(3)(4)(5)(6)(17)(18)(19)(20).…”

Section: Discussionsupporting

confidence: 77%

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Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Treiyer¹,

Saar²,

Bütow³

et al. 2012

Int. braz j urol.

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InTRODUcTIOnRobotic-assisted laparoscopic radical cystectomy has become a surgical option for patients with bladder cancer, providing the benefi ts of minimal invasive surgery with lower blood loss, early return of bowel function and more rapid patient recovery, while apparently maintaining functional and oncological outcomes (1-6). The surgical and perioperative outcomes of initial reports appear to be comparable to the open approach. However, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical and oncological method for patients with bladder cancer. We report our initial experience with robotic assisted laparoscopic radical cystectomy, evaluating the perioperative and pathological outcomes of this procedure.Purpose: Our fi rst 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. Materials and Methods: Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. Results: Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min.) and mean blood loss was 294 mL (range: 50-2000 mL). In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classifi ed as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1%). Mean days to fl atus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11% major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. Conclusions: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes. Robotic

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“…With regards to perioperative outcomes a mean robotic operating time of 265 min is comparable with the results published in other studies (1)(2)(3)(4)(5)(6)(17)(18)(19)(20).…”

Section: Discussionsupporting

confidence: 77%

“…Similarly, we described a low surgical blood loss that contributes to a faster postsurgical recovery as was demonstrated in other robotic cystectomy reports (1)(2)(3)(4)(5)(6)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 57%

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Treiyer¹,

Saar²,

Bütow³

et al. 2012

Int. braz j urol.

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“…The data recording used International Index of Erectile Function (IIEF) scores in five of seven series. However, only three series provided a clear definition of potency [12,35,56].…”

Section: Functional Informationmentioning

confidence: 99%

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

et al. 2015

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Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.Objective: To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.Evidence synthesis: The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-31% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC.Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-22% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 53-74%, 68-83%, and 72-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Conclusions

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“…Many centers perform RARC and then carry out the ileal conduit urinary diversion or orthotopic neobladder extra-corporeally [7][8][9]. With increased experience and techniques as well as decreased operative times, more and more centers are now adopting intra-corporeal reconstruction [10,11].…”

Section: Techniquesmentioning

confidence: 99%

“…With increased experience and techniques as well as decreased operative times, more and more centers are now adopting intra-corporeal reconstruction [10,11]. A few centers are adopting a team approach to RARC, where one team performs the cystectomy and lymphadenectomy and another performs the reconstruction [7]. Although this may decrease the surgical stress on the operating surgeon, whether this approach improves the functional and oncological outcomes is yet to be seen.…”

Section: Techniquesmentioning

confidence: 99%

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

Rao

Stegemann

Rehman

et al. 2012

Indian J Surg Oncol

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Robot-assisted radical cystectomy (RARC) for bladder cancer is increasingly becoming popular in specialist centres around the world. RARC has the advantage of being minimally invasive and also the dexterity of the instruments allow reconstruction such as ileal conduit urinary diversion or neobladder formation. Starting from the initial series demonstrating the feasibility of RARC and extended pelvic lymph node dissection, we now have mature series demonstrating equal oncological and functional outcomes in the medium term follow-up. In addition, literature suggests decreased hospital stay, less blood loss equating to less blood transfusion and a trend towards decreased complications as well. In the near future we would anticipate further refinement and reduced operating times with increased benefits for the patient undergoing RARC.

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Robotic-assisted Laparoscopic Radical Cystectomy with Extracorporeal Urinary Diversion: Initial Experience

Cited by 155 publications

References 26 publications

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

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

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

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