Robotic Assisted Laparoscopic Radical Cystoprostatectomy: Operative and Pathological Outcomes

Abstract

Recent small case series have now been reported for robotic assisted laparoscopic radical cystoprostatectomy. We report our initial experience with robotic assisted laparoscopic radical cystoprostatectomy, evaluating the perioperative and pathological outcomes of this novel procedure. A total of 20 men underwent robotic assisted laparoscopic radical cystoprostatectomy and extracorporeal urinary diversion for clinically localized bladder cancer. Outcome measures evaluated in this series were operative variables, hospital recovery, pathological outcomes and complication rate. Comparisons were made to 24 gender matched men who underwent an open procedure during the same period. Mean patient age was 62.3 years (range 54 to 76). Ten patients underwent ileal conduit diversion and 10 received an orthotopic neobladder. In all cases urinary diversion was performed extracorporeally. Mean operative time for robotic cases was 6.1 hours, including 5.2 hours in the most recent 10 cases. This was longer than in patients undergoing an open procedure (3.8 hours). Mean surgical blood loss was 313 ml, which was significantly less than in those undergoing open cystectomy (588 ml). On surgical pathology 14 cases were pT2 or less, 4 were pT3 and 2 were N+. In no case was there inadvertent entry into the bladder or positive surgical margins. A mean of 19 lymph nodes was removed. Mean time to flatus was 2.1 days and mean time to bowel movement was 2.8 days, which was significantly shorter than in men undergoing an open procedure. Of the patients 16, 3 and 1 were discharged home on postoperative days 4, 5 and 8, respectively. There were a total of 6 postoperative complications (30%) in 5 patients. Our initial experience with robotic assisted laparoscopic radical cystoprostatectomy appears to be favorable with acceptable operative, pathological and short-term clinical outcomes. As our experience increases, we expect to continue to refine our surgical technique and decrease operative time.