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Introduction: Intracorporeal urinary diversion after robotic cystectomy is currently limited to highly-specialized centers. Information regarding the initial experience of starting a program in totally robotic radical cystectomy is sparse.
Materials & Methods: Prior to program initiation, two fellowship-trained attending surgeons with robotic cystectomy experience observed intracorporeal ileal conduit creation at a high-volume center, and subsequently performed all operations together as a team. We recorded peri-operative outcomes, complications (Clavien classification), and operative times for each case step. Linear regression trended operative times with experience.
Results: From 2013-2015, we performed 24 totally robotic radical cystectomies. 10 patients had neoadjuvant chemotherapy; 3 had prior radiation. Mean lymph nodes examined was 25 (range 11 - 72). Mean EBL was 386 mL. Median hospital stay was 6 days; 58% stayed <7 days. Overall complication rate was 62%; major (Clavien ≥ 3) complication rate was 29%. For 19 patients with granular operative time information, mean operative time from induction to close was 468 minutes. Operative times for the right (-1.1 min/case) and left (-0.8 min/case) ureteroileal anastomoses, urostomy (-0.8 min/case), and the total operation (-2.5 min/case) decreased with experience.
Conclusions: With sufficient expertise, starting a program in totally robotic radical cystectomy is feasible, with outcomes similar to the reported literature. Given long operative times and high complexity, we recommend a team approach. A significant learning curve exists; operative times decrease with experience.