Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: Initial experience

Background: The use of robotic technology for laparoscopic prostatectomy is now well established. The same cannot yet be said of robotic-assisted laparoscopic radical cystectomy (RARC), which is performed in just a few centres worldwide. Objective: We present our technique and experience of this procedure using the da Vinci surgical system. Design, setting, and participants: From 2004 to 2007, 23 patients underwent RARC and urinary diversion at our institution. Surgical procedure: We report the development of our technique for RARC, which involves posterior dissection, lateral pedicle control, anterior dissection, and lymphadenectomy prior to either ileal conduit urinary diversion or Studer pouch reconstruction performed extracorporeally. Measurements: Demographic and perioperative data were recorded prospectively. Oncologic and functional outcomes were assessed at 3- to 6-mo intervals. Results and limitations: To date, 23 patients have undergone this procedure at our institution. Of those, 19 had ileal loop urinary diversion and 4 were suitable for Studer pouch reconstruction. Mean total operative time plus or minus (+/-) standard deviation (SD) was 397 +/- 83.8 min. Mean blood loss SD was 278 +/- 229 ml with one patient requiring a blood transfusion. Surgical margins were clear in all patients with a median SD of 16 +/- 8.9 lymph nodes retrieved. The complication rate was 26%. At a mean follow-up SD of 17 +/- 13 (range 4-40) mo, one patient had died of metastatic disease and one other is alive with metastases. The remaining 21 patients are alive without recurrence. Conclusions: RARC remains a procedure in evolution in the small number of centres carrying out this type of surgery. Our initial experience confirms that it is feasible with acceptable morbidity and good short-term oncologic results. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.