Robot-Assisted Radical Cystectomy and Pelvic Lymph Node Dissection: Initial Experience at Roswell Park Cancer Institute
ABSTRACT One series of robot-assisted radical cystectomy with pelvic lymph node dissection has been reported. We report our operative technique and initial experience.
Twenty consecutive patients underwent robot-assisted radical cystectomy, pelvic lymph node dissection, and open urinary diversion for operable bladder cancer from October 2005 to June 2006. Data were collected prospectively on patient demographics, intraoperative parameters, pathologic staging, and postoperative outcomes.
The mean patient age was 70 years (range 56 to 90). The mean body mass index was 26 kg/m2 (range 17.3 to 36). Fourteen patients had undergone previous abdominal surgery. The mean operative time was 197 minutes for robot-assisted radical cystectomy, 44 minutes for pelvic lymph node dissection, and 133 minutes for urinary diversion. The mean blood loss was 555 mL. One case was converted to an open procedure because of the patient's inability to tolerate the Trendelenburg position. The mean hospital stay was 10 days. Two patients had major complications. One patient had positive vaginal margins and 9 of 26 nodes were positive. Four patients had incidental prostate cancer. The mean time to the return to nonstrenuous activity was 4 weeks and to strenuous activity was 10 weeks.
Robot-assisted radical cystectomy and pelvic lymph node dissection can be performed safely in patients who are considered candidates for open cystectomy. Long-term oncologic control data and functional outcomes are needed to assess the true benefits of robot-assisted radical cystectomy.
- SourceAvailable from: Gregory Boustead
[Show abstract] [Hide abstract]
- "Robotic-assisted radical cystectomy (RARC) with extracorporeal diversion has become an established alternative to open radical cystectomy (ORC) in many specialist centres worldwide      . More recently, we have seen the evolution of robotic intracorporeal ileal conduit (RICIC) formation, although this is still relatively in its infancy and is limited to a handful of centres    . "
ABSTRACT: Objectives. To describe our technique of robotic intracorporeal ileal conduit formation (RICIC) during robotic-assisted radical cystectomy (RARC). To report our initial results of this new procedure. Patients and Methods. Seven male and one female patients underwent RARC with RICIC over a six-month period. Demographic, operative, and outcome data was collected prospectively. Median patient age was 75 years (range 62-78 years). Median followup was 9 months (range 7-14 months). Results. RARC with RICIC was performed successfully in all eight patients. The median total operating time was 360 minutes (range 310-440 minutes) with a median blood loss of 225 mL (range 50-1000 mL). The median length of stay was nine days (range 6-34 days). Four patients (50%) were discharged within seven days. Four patients (50%) experienced one or more complications. This included two Clavien I complications, two Clavien II complications, and two Clavien III complications. Two patients (25%) required transfusion of two units each. To date, there have been no complications associated with the ileal conduit. Conclusion. Whilst being technically challenging, this procedure is safe, feasible, and reproducible. Patients who avoid complication show potential for rapid recovery and early discharge.Advances in Urology 09/2013; 2013:642836. DOI:10.1155/2013/642836
[Show abstract] [Hide abstract]
- "Early oncologic outcomes of robotassisted RC (RARC) reported by a limited number of specialized centers appear similar to RC, with an effort to reduce procedure-related complications. In 2003, Menon first reported his series of RARC as a minimally invasive approach toward attaining this goal, followed by various case series with limited complication details   . "
ABSTRACT: Background Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. Objective To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. Design, setting, and participants Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. Outcome measurements and statistical analysis Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. Results and limitations Forty-one percent (n = 387) and 48% (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1–2 in 29%, and grade 3–5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. Conclusions Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling. Take Home Message Our goal was to describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. When using multi-institutional data, surgical morbidity after RARC is significant, but most complications are low grade.European Urology 01/2013; 64(1). DOI:10.1016/j.eururo.2013.01.010 · 13.94 Impact Factor
[Show abstract] [Hide abstract]
- "With the introduction of robot-assisted laparoscopic surgery with three-dimensional vision, a 10- fold magnification, and dexterity provided by the endowrist instrumentation, robot-assisted radical cystectomy (RARC) has emerged as an alternative to the open procedure. Most RARC surgeons advocate a combination of robot-assisted laparoscopy and open surgery, performing the cystectomy and lymphadenectomy with the robot, and, due to longer operative time     , using an extracorporeal approach for the construction of the conduit or neobladder . However, some centres, including our own institution, have developed techniques for RARC with a complete intracorporeal urinary diversion  . "
ABSTRACT: Robot-assisted radical cystectomy (RARC) may reduce morbidity after cystectomy. Descriptions of the surgical techniques of RARC with intracorporeal orthotopic neobladder or ileal conduit are sparse and oncologic and functional outcome data have not been reported. We present our technique with RARC and intracorporeal urinary diversion (neobladder or ileal conduit) and present oncologic and functional outcomes, as well as complication rates. Single-hospital institution case-series from 2004 to 2009 including 45 selected patients (38 male, 7 female) with high-grade and/or muscle-invasive urothelial cancer of the bladder. We performed RARC; pelvic lymph node dissection using three different templates; and a totally intracorporeal urinary diversion, either orthotopic neobladder (n=36) or ileal conduit (n=9). Perioperative variables, pathology data, early and late complication rates, urinary continence, potency, and cancer-specific survival were evaluated as outcome measures. Median patient age, operative time, estimated blood loss, and lymph node yield were 62 yr (range: 37-79), 477 min (range: 325-760), 550 ml (range: 200-2200), and 19 (range: 10-52), respectively. Nine patients were diagnosed with positive lymph nodes. Surgical margins were clear in all but one patient. Early complications occurred in 18 patients (40%). Median postoperative stay was 9 d (range: 4-78), and median postoperative follow-up time was 25 mo. Four patients died due to metastatic disease. The study is limited by a relative small sample size and no comparative group. RARC with totally intracorporeal urinary diversion is technically feasible with good intermediate-term oncologic results. This is a nonrandomised study including a limited number of patients with a restricted follow-up time, however, and so precautions must be considered when interpreting the outcomes.European Urology 08/2011; 60(5):1066-73. DOI:10.1016/j.eururo.2011.07.035 · 13.94 Impact Factor