Robot-Assisted Radical Cystectomy Using a Side-Docking Technique

Purpose: Robot-assisted radical cystectomy (RARC) was first introduced in 2003. Although there have been modifications to the surgical techniques over the years, in every published RARC series the surgical robot is invariably docked between the patient's legs. We evaluated the use of a side-docking approach in RARC. Patients and Methods: Ten RARCs using a side-docking technique were performed at a single institute between February 2013 and February 2014. The patients' clinical notes and operative findings were reviewed. The results were compared with results from RARCs using the conventional central-docking method from our historical cohort. Results: There were no significant arm collisions in the side-docking RARC procedures. The perineum was readily accessible in all cases that used the side-docking method. A simultaneous urethrectomy was performed in 1 case with a side-docking approach. The median operative times were 417.5 minutes (range, 345-515 minutes) and 405.0 minutes (range, 330-500 minutes) in the central-docking and side-docking groups, respectively. There were no statistically significant differences in operation time, transfusion rate, complication rate, or hospital stay between the two groups. Conclusions: A side-docking approach in RARC provides better perineal access with the advantage of allowing simultaneous urethrectomy and transvaginal retrieval of the specimen without compromising the dexterity and precision of the robotic surgical system.