Robot-assisted radical cystectomy: state of art and future perspectives

Abstract

Bladder cancer (BC) remains one of the most common cancer worldwide. Radical cystectomy (RC) and pelvic lymph node dissection (PLND) with urinary diversion (UD) is still considered the gold standard treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for recurrent non-muscle invasive disease. The open approach remains the reference option of treatment for RC, even if robotic surgery is rapidly increasing. Nowadays, several studies have reported perioperative, functional and oncological outcomes of robot-assisted radical cystectomy (RARC), but data are still immature to compare both procedures. All the current randomized controlled trials (RCTs), did not prove any significant difference between open RC and RARC, underlining no superiority between both procedures. Therefore, RARC is still considered an investigational procedure. On the other hand, modern robotic surgical practice has been evolved by the introduction of innovative technologies. The technological progress is improving, in particular in robotic surgery, offering several future perspectives, such as the ICG technique. The aim of the review is to describe the state of art, and to outline future perspectives of RARC, in order to establish the role of robotic surgery in the complex field of radical cystectomy.