The Benefit of Robotic Surgery in Postradiorecurrent Invasive Bladder Cancer

Abstract

Introduction: Recurrence of invasive bladder cancer after radiation therapy poses a surgical challenge with significant morbidity described for salvage cystectomy cases. This video presents a series of robot-assisted salvage radical cystectomies (RSRCs) with detailed description of the key steps, in addition to perioperative and oncologic outcomes. Materials and Methods: With IRB approval, four patients who underwent RSRC were identified from a prospective database. The key steps of RSRC presented in the video include posterior dissection aided by magnification and three-dimensional vision of the robotic system, completion of cystectomy, adequate lymphadenectomy, and intracorporeal ileal conduit reconstruction. Results: The median age was 63 years and all Eastern Cooperative Oncology Group status was 1 or better. The preoperative clinical staging was cT3N0M0 in all cases. The median console operative time was 450 minutes, estimated blood loss 200 mL, length of stay 5 days, duration of ileus 3 days, and there were no transfusions. There was one patient with prolonged ileus (7 days) but there were no other Clavien-Dindo III and above complications. There were no rectal or vascular injuries. The pathologic stages include pT4 (n = 2), pT3 (n = 1), and pT2 (n = 1). The median node count was 25, and n = 1 patient was node positive. At a median follow-up of 18 months, two patients developed systemic recurrence. Conclusions: This video presents a series of RSRCs demonstrating that it is safe and oncologically feasible. The robotic vision aids meticulous dissection in an irradiated surgical field with minimal adverse events. No competing financial interests exist. Runtime of video: 6 mins 51 secs