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BACKGROUND: Radical cystectomy remains a technically challenging procedure with considerable morbidty. Recently surgeons have begun to describe outcomes associated with less invasive surgical approaches such as laparoscopic or robotic cystectomy. I report my maturing experience with 87 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes, and surgical complications.
METHODS: A total of 87 consecutive patients (69 male and 18 female) underwent robotic radical cystectomy and urinary diversion by a single surgeon from January 24, 2003-March 14, 2013. Malignancy was the indication for 84 patients and benign conditions for 3 patients. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes, and complication rates.
RESULTS: Mean age of this cohort was 66 years (median 67; range 20 to 87). 55 underwent ileal conduit diversion, 19 received a neobladder and 12 received an Indiana Pouch. 1 patient rendered anephric did not receive a diversion. Urinary diversion was performed intracorporeal or extracorporeal depending on the clinical situation. Mean operating room times included any necessary concurrent procedures such as unilateral or bilateral laparoscopic nephroureterectomy, inguinal node dissection, total vaginectomy, hernia repair, etc. Mean operating room time for all patients was 459 minutes (median 436; range 293-878) and mean surgical blood loss was 479 cc (median 350; range 50-2,200). 36/84 (42.9%) were pT3/T4 and 21/84 (25%) were node positive. Mean number of lymph nodes removed was 22 (median 20; range 7-54). 6/84 (7.1%) had a positive margin, all ≥pT3b. Mean LOS was 10 days (median 8; range 5-32). There were 38 postoperative complications in 33 patients (38%) with 11/38 (28.9.5%) being a major complication (Clavien grade 3 or higher). There were no 30 day mortalities. There were 4 90 day mortalities: 2 secondary to surgery and 2 secondary to rapidly advancing metastatic disease.
CONCLUSIONS: This series represents a relatively large and maturing experience with robotic radical cystectomy for the treatment of both malignant and benign conditions with acceptable surgical and pathological outcomes. These results support continued efforts to refine robotic
cystectomy and urinary diversion.