Robot-Assisted Laparoscopic Anterior Pelvic Exenteration for Bladder Cancer in Women

Abstract

Introduction: Recent small case series have now been reported for robot-assisted laparoscopic radical cystectomy. Herein, we report our initial experience with robot-assisted laparoscopic anterior pelvic exenteration in women with bladder cancer, and describe stepwise the surgical procedure itself and evaluate perioperative and pathologic outcomes of this novel procedure. Methods: Ten women underwent robot-assisted laparoscopic anterior pelvic exenteration and extracorporeal urinary diversion for clinically localized bladder cancer. Mean age was 68.4 years (range, 61–79 years). The stepwise operative procedure is described in detail. Outcome measures evaluated in this series included operative variables, hospital recovery, pathologic outcomes, and complication rate. Results: Seven patients underwent ileal conduit diversion and three patients underwent an orthotopic neobladder. In all cases the urinary diversion was performed extracorporeally. Mean operating room (OR) time was 4.6 hours, and mean surgical blood loss was 215 mL. On surgical pathology, five patients were ≤pT2, three patients pT3, and two patients N+. In no case was a positive surgical margin, and in one case there was inadvertent entry into the bladder. Mean number of lymph nodes removed was 19 (range, 12–34). Mean time to flatus was 1.9 days, and bowel movement 2.4 days, and time to discharge 4.9 days. Five patients were discharged on postoperative day (POD) 4, three patients on POD 5, one on POD 6, and one on POD 8. There were two postoperative complications (20%) in two patients. Conclusions: Our initial experience with robot-assisted laparoscopic anterior pelvic exenteration appears to be favorable with acceptable operative, pathological, and short-term clinical outcomes. As our experience increases, we should expect to continue to refine our surgical technique and reduce operating room times. Certainly, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical and oncologic option. Runtime of video: 9 min 29 sec