Phone: (212) 746-5788
Fax: (212) 746-0975
Urology
- Adrenal Cancer
- Kidney Cancer
- Bladder Cancer
- Prostate Cancer
- Ureteral Cancer
- Testicular Cancer
- Urologic Sarcoma
Procedures
- Adrenalectomy
- Nephrectomy
- Robotic Cystectomy
- Robotic Prostatectomy
- Ureteral Cancer Treatment
- Testicular Cancer Treatment
- Urologic Sarcoma Treatment
Experience with Robotic-Assisted Laparoscopic Radical Cystectomy: Peri-Operative and Short Term Oncologic Outcomes.
Introduction and objective: Robotic-assisted laparoscopy has emerged as a feasible, albeit technically challenging, approach to radical cystectomy. However, outcomes data for this procedure have thus far been largely limited to small case series. Here, we describe a single surgeon’s experience in what to our knowledge is the largest series to date involving this procedure.
Methods: We reviewed cases for 54 consecutive bladder cancer patients undergoing robotic-assisted laparoscopic radical cystectomy by a single surgeon at a single institution. Outcome measures included operative variables, hospital recovery (length of stay, diet), peri-operative complications, tumor pathology and disease status.
Results: Mean patient age was 69.8 years (range 37-93), with a mean body max index (BMI) of 26.1 (range 18.7-33.3) and mean ASA score of 2.4. Type of operative urinary diversion included ileal conduit (59%), neobladder (31%) and Indiana Pouch (9%). Operative time was on average 6.3 hours (range 3.5-9.7 hours), and mean surgical blood loss was 433 ml, with transfusion required in 8 cases (14.8%). Post-operatively, liquid and regular diets were started on average on post-operative days 4 and 5, respectively. Mean day of discharge was post-operative day 6. The peri-operative complication rate was 27.8%, with most being grade I. Grade III complications included abdominal abscess or fistula, deep vein thrombosis, and pulmonary embolus. On univariate analysis, peri-operative complications correlated with intra-operative blood transfusion but not with blood loss, operative time, BMI, age, or ASA score. On final pathology, 8 patients (15%) had no evidence of disease (pT0), 16 patients (29%) had non-invasive disease (pTis, pTa, pT1), and 30 patients (56%) had invasive disease (pT2-pT4). Ten patients (19%) had nodal involvement, with a mean of 19.6 lymph nodes were removed for all patients. One patient (2%) had a positive surgical margin. At a median follow up of 5.4 months, 42 patients (78%) were alive without disease, 5 patients (9%) were alive with disease, and 7 patients (13%) had died of cancer or other causes.
Conclusions: In the hands of an experienced laparoscopist, robotic-assisted laparoscopy is a safe approach for patients undergoing radical cystectomy. Longer operative times do not appear to contribute to peri-operative complications, and the majority of complications require only low level of intervention. While early oncologic outcomes appear to be comparable to the open approach, long-term follow up, preferably with head-to-head comparisons, is needed.