The feasibility of robot-assisted radical cystectomy: an experimental study.

Abstract

To investigate the feasibility of the avatera system for performing robot-assisted radical cystectomy (RARC) followed by intracorporeal reconstruction of ileal neobladder. Six anesthetized female pigs were used to perform RARC and formation of the intracorporeal orthotopic ileal neobladder. Three surgeons with different level of expertise in the use of robotic systems performed RARC after a short instructional lecture and a 2-h hands-on training. The urinary diversion phase was performed only by the experienced surgeon. The successful completion of the procedure, operative time for demolitive and reconstructive phases, intraoperative blood loss and malfunction of the robotic system were evaluated. An improvement of the operative time was observed for each surgeon. The experienced surgeon, the fellow and the resident improved their time by 11, 15, and 22min, respectively, between the first and the second RARC performed. The most significant time difference was demonstrated by the resident, who had no previous experience in using robotic systems. The time difference between the first and the last orthotopic ileal neobladder creation for the experienced surgeon was 51min. The feasibility of avatera system for performing complex surgical procedure such as RARC with intracorporeal neobladder formation was demonstrated by this experimental study. No major bleeding or severe malfunctions were observed during the procedures. Significant improvement in operative time was demonstrated with the increasing experience from 1st to 6th case.