Comparative Analysis of Laparoscopic and Robot-Assisted Radical Cystectomy with Ileal Conduit Urinary Diversion

Abstract

To compare our experience with laparoscopic radical cystectomy (LACIC) and robot-assisted laparoscopic radical cystectomy (RACIC) with ileal conduit urinary diversion. Prospective data were gathered on 20 consecutive patients undergoing LACIC performed between August 2002 and July 2005, and on 14 consecutive patients undergoing RACIC performed between March 2005 and December 2006. Radical cystectomy with pelvic lymphadenectomy was performed laparoscopically or robotically, and an ileal conduit urinary diversion was performed extracorporeally. There was no significant difference in terms of preoperative factors or baseline tumor characteristics and no significant difference in mean operative time (410 min v 419 min) between groups. There was less blood loss (212 mL v 653 mL; P < 0.0001) and fewer transfusions (42.8% v 70%; P < 0.0011) in the RACIC group. There was one intraoperative complication (7%) and no conversions in the RACIC group. There were three (15%) intraoperative complications all leading to conversion in patients undergoing LACIC. Three (21%) patients in the RACIC group and 10 (50%) patients in the LACIC group had at least 1 post-operative complication. The mean number of days to oral intake was less in the RACIC group (2.3 v 6.1; P = 0.012). There was no significant difference in the number of lymph nodes excised (P = 0.09) between groups. Bilateral extended lymphadenectomy was performed in 10 (71%) RACIC patients with a mean of 22.3 lymph nodes harvested and in 16 (80%) LACIC patients with a mean of 16.5 lymph nodes harvested. There were no positive margins in patients in the LACIC group and one (7.1%) among patients in the RACIC group--a patient with pT4 disease. Both laparoscopic and robot-assisted radical cystectomies can be performed safely without compromising oncologic standards for surgical margins and extent of lymphadenectomy. In this early experience, the robot-assisted approach appears to have a shorter learning curve, and it is associated with less blood loss, fewer postoperative complications, and earlier return of bowel function than LACIC.