Robotic Cystectomy Research Articles

Current management of radiation cystitis after pelvic radiotherapy: a systematic review.

We aimed to summarize current literature about radiation cystitis treatments, providing physician of a summary of current management options. A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in March 2021. PRISMA guidelines were followed. Population consisted of patients with a diagnosis of radiation cystitis after pelvic radiotherapy (P). We focused our attention on different treatments, such as conservative or surgical one (I). Single or multiple arms studies were deemed eligible with no mandatory comparison (C). Main outcomes of interest were symptoms control and adverse events rates (O). The search identified 1194 records. Of all, four studies focused on the use of hyperbaric oxygen therapy showing complete response rates ranging from 52% to 87% approximately. Oral administration of cranberry compounds was investigated in one study showing no superiority to placebo. Intravesical instillation of different compounds were investigated in five studies showing the highest complete response rates after alum (60%) and formalin administration (75%). Endoscopic conservative surgical treatments (fibrin glue or vaporization) also showed 75% complete response rates. In patients who did not respond to conservative treatments robotic cystectomy is feasible with overall complication rates of about 59.3% at 90 days. Radiotherapy induced cystitis is an under-reported condition after pelvic radiotherapy. Several treatments have been proposed, but in up to 10% of cases salvage cystectomy is necessary. A stepwise approach, with progressive treatment aggressiveness is recommended.

Update on robotic cystectomy.

This article aims to discuss recently published (2019-2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics. RARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming. ORC is the current 'gold standard' management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed-informing further adoption of the technique.

Orthotopic bladder substitution: Surgical aspects and optimization of outcomes.

ObjectivesOrthotopic bladder substitution (OBS) is a management option for urinary diversion in men and women undergoing cystectomy. The aim of the procedure is to provide a functional continent urinary reservoir of adequate capacity, compliance and low pressure. We have provided a narrative review of the existing literature and highlighted areas where improvement and standardization can be recommended.MethodsLiterature search included database search for publications from January 1970 to November 2020, using keywords including OBS, bladder reconstruction, neobladder, radical cystectomy, robotic cystectomy, intracorporeal neobladder, surgical technique, patient selection and outcomes.ResultsDue to various factors including indications, operative technique and risk of complications, OBS is an enormous undertaking and commitment for patients, surgeons and health professionals involved in the care pathway. The main considerations for patient selection, the technical elements of the procedure and the rationale behind these are discussed. Previously considered to be a choice for a select few, the inclusion criteria have expanded over the last decade. Similarly, surgical techniques including the choice and configuration of bowel segments, construction of anastomosis and nerve or organ sparing procedures have evolved over the years. Minimally invasive laparoscopic and robotic assisted surgery has added further perspectives to the existing literature on OBS. Understanding the principles of operative techniques and assessing the best evidence to influence patient management is crucial as it has a major impact on clinical outcomes. Peri‐ and post‐operative care, focused on the prevention of complications and morbidity, affects long‐term functional and oncological outcomes, which ultimately dictates the quality of life.ConclusionsThis concise overview of OBS literature highlights the importance of pre‐operative, peri‐operative, and post‐operative aspects with regards to the optimization of patient care. To achieve the best results, meticulous attention should be paid in all these areas, surgical and multi‐disciplinary. Patient education and counseling, with shared decision making are central to the success of the procedure.

Robotic Intracorporeal Ileal Conduit Urinary Diversion Technique.

The gold standard surgical treatment for muscle invasive bladder cancer is radical cystectomy and urinary diversion. This procedure has historically been performed as an open surgery. With the advances of robotic surgery, robotic cystectomy and urinary diversion has gained popularity with the ability to perform intracorporeal urinary diversions in addition to extirpative surgery. Herein, we detail our technique for intracorporeal ileal conduit.

PD59-03 INTRACORPOREAL VERSUS EXTRACORPOREAL NEOBLADDER AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM

You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-03 INTRACORPOREAL VERSUS EXTRACORPOREAL NEOBLADDER AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM Zafardjan Dalimov, Umar Iqbal, Zhe Jing, Andrew A. Wagner, Prokar Dasgupta, Mohammed S. Khan, Morgan Roupret, Juan P. Redorta, Abolfazl Hosseini, Peter Wiklund, Carl Wijburg, Alexandre Mottrie, Ketan Badani, Jihad Kaouk, Eric Kim, Derya Balbay, Franco Gaboardi, Ashok Hemal, Lee Richstone, Ahmed Aboumohamed, James Peabody, Johar R. Syed, Ahmed A. Hussein, and Khurshid A. Guru Zafardjan DalimovZafardjan Dalimov More articles by this author , Umar IqbalUmar Iqbal More articles by this author , Zhe JingZhe Jing More articles by this author , Andrew A. WagnerAndrew A. Wagner More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Mohammed S. KhanMohammed S. Khan More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Juan P. RedortaJuan P. Redorta More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Peter WiklundPeter Wiklund More articles by this author , Carl WijburgCarl Wijburg More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Ketan BadaniKetan Badani More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Eric KimEric Kim More articles by this author , Derya BalbayDerya Balbay More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Ashok HemalAshok Hemal More articles by this author , Lee RichstoneLee Richstone More articles by this author , Ahmed AboumohamedAhmed Aboumohamed More articles by this author , James PeabodyJames Peabody More articles by this author , Johar R. SyedJohar R. Syed More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to compare perioperative and oncologic outcomes of intracorporeal (ICNB) and extracorporeal (ECNB) following robot assisted radical cystectomy (RARC). METHODS: A retrospective review (2005-2020) of International Robotic Cystectomy Consortium (IRCC) database was performed. The Cochran-Armitage trend test was used to assess utilization of ICNB over time. ICNB and ECNB recipients were compared in terms of perioperative, oncologic and survival outcomes. Multivariable analysis was used to identify variables associated overall complications, high-grade complications, and readmissions. Kaplan Meier curves were used to depict recurrence free (RFS), disease specific (DSS), and overall survival (OS). RESULTS: 318 patients received neobladder, 67% underwent ICNB. ICNB utilization increased significantly over time (p<0.01). Patients who received ICNB experienced fewer 30-d reoperations (1% vs 10%, p<0.01). There were no significant differences in overall and high-grade complications. They experienced fewer gastrointestinal (8% vs 22%, p<0.01) and thromboembolic complications (7% vs 25%, p<0.01). They were readmitted more frequently (38% vs 22%, p=0.04) (Table 1). On multivariate analysis, ICNB was significantly associated with readmissions (OR 2.19 95% CI 1.06-4.54, p=0.03) (Table 2). Both groups exhibited similar RFS, DSS, and OS (log rank p=0.34, 0.16, and 0.11, respectively) (Figure 1). CONCLUSIONS: Patients who underwent ICNB had fewer 30-d reoperations, gastrointestinal and thromboembolic complications but were readmitted more frequently compared to those who received ECNB. Long term oncological and survival outcomes were similar between ICNB and ECNB recipients. Source of Funding: Roswell Park Alliance Foundation and the Vattikuti Foundation Collective Quality Initiative © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1052-e1052 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zafardjan Dalimov More articles by this author Umar Iqbal More articles by this author Zhe Jing More articles by this author Andrew A. Wagner More articles by this author Prokar Dasgupta More articles by this author Mohammed S. Khan More articles by this author Morgan Roupret More articles by this author Juan P. Redorta More articles by this author Abolfazl Hosseini More articles by this author Peter Wiklund More articles by this author Carl Wijburg More articles by this author Alexandre Mottrie More articles by this author Ketan Badani More articles by this author Jihad Kaouk More articles by this author Eric Kim More articles by this author Derya Balbay More articles by this author Franco Gaboardi More articles by this author Ashok Hemal More articles by this author Lee Richstone More articles by this author Ahmed Aboumohamed More articles by this author James Peabody More articles by this author Johar R. Syed More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement Loading ...

PD59-05 SINGLE-PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL BOWEL DIVERSION: INITIAL EXPERIENCE AND REVIEW OF EARLY SURGICAL OUTCOMES

You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-05 SINGLE-PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL BOWEL DIVERSION: INITIAL EXPERIENCE AND REVIEW OF EARLY SURGICAL OUTCOMES David Ali, Rohan Sawhney, Mubashir Billah, Robert Harrison, Michael Stifelman, Gregory Lovallo, Nikhil Gopal, Jay Zaifman, Salma Ahsanuddin, Tenzin Lama-Tamang, Helaine Koster, and Mutahar Ahmed David AliDavid Ali More articles by this author , Rohan SawhneyRohan Sawhney More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Robert HarrisonRobert Harrison More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Nikhil GopalNikhil Gopal More articles by this author , Jay ZaifmanJay Zaifman More articles by this author , Salma AhsanuddinSalma Ahsanuddin More articles by this author , Tenzin Lama-TamangTenzin Lama-Tamang More articles by this author , Helaine KosterHelaine Koster More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Scant literature is available on surgical outcomes of radical cystectomies on the new single-port (SP) system. This study compares short term outcomes in patients undergoing radical cystectomy with intracorporeal urinary diversion (ICUD) on the multi-port (MP) vs. SP platform. METHODS: This IRB approved study used a prospective cystectomy database and non-parametric testing including Chi-Squared, Mann-Whitney U, and Fisher Exact tests to analyze all variables stratified by surgical approach. RESULTS: 34 patients underwent radical cystectomy with ICUD from 9/1/2019 to 2/8/2021. 20 patients were in the MP cohort, while 14 were in the SP group. Table 1 presents the demographics of both groups and shows no significant differences. Intra- and post-operative as well as pathology data is shown in Table 2. Patients in the SP group had less narcotic use (MP: 25 MME vs. SP: 11.5 MME, p=0.047) and shorter return of bowel function (MP: 3 days vs. SP: 2 days, p=0.032). Operative times were similar between both groups despite having fewer patients undergoing ileal conduit (MP: 85% vs. SP: 50%, p=0.027) in the SP group. In table 3, the early short term post-operative follow up data for each group showed no significant differences between the two groups with an average follow up of 4.9 months for MP and 4.4 months for SP. CONCLUSIONS: Our initial experience with SP robotic cystectomy and ICUD appears to be safe and an effective alternative to MP cystectomies. A learning curve was involved but the overall transition from MP to SP was smooth. Operative times were similar despite fewer patients undergoing ileal diversion, shorter return of bowel function, and less narcotic use in the SP group. Further studies including longer follow ups with multi-institutional data are underway. Source of Funding: None. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1053-e1055 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ali More articles by this author Rohan Sawhney More articles by this author Mubashir Billah More articles by this author Robert Harrison More articles by this author Michael Stifelman More articles by this author Gregory Lovallo More articles by this author Nikhil Gopal More articles by this author Jay Zaifman More articles by this author Salma Ahsanuddin More articles by this author Tenzin Lama-Tamang More articles by this author Helaine Koster More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

MP13-09 RELAPSES RATES AND PATTERNS FOR PATHOLOGICAL T0 AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM

INTRODUCTION AND OBJECTIVE:We investigated the outcomes of pT0 after robot-assisted radical cystectomy (RARC).METHODS:A retrospective review of the International Robotic Cystectomy Consortium datab...

Open, laparoscopic or robotic radical cystectomy: which is the best surgical approach?

Open, laparoscopic or robotic radical cystectomy: which is the best surgical approach?

Single Incision Robotic Cystectomy and Hybrid Orthotopic Neobladder Reconstruction: A Step by Step Description

To describe a new technique for single incision robotic cystectomy and Studer-type ileal neobladder using the single-port (SP) da Vinci SP robotic platform. In April 2021, a 71 year-old patient underwent a single incision robotic cystectomy and orthotopic Studer-type ileal neobladder using the single-port da Vinci SP robotic platform for cT2, cN0 urothelial carcinoma of the bladder. He was not a candidate for neoadjuvant cisplatin-based combination chemotherapy and declined participation in a clinical trial. Total operative time was 554 minutes and estimated blood loss was 250 cc. He was discharged on postoperative day six without developing any Clavien complications. He underwent adjuvant chemotherapy for node-positive disease and follow-up through June 2021 was notable for the absence of any significant complications or readmissions. We provide a comprehensive discussion of the required instrumentation, a description of the technique with illustrations, and discuss the advantages and disadvantages of this technology as it pertains to cystectomy and urinary diversion. We make no claim regarding the superiority of this technique over others, only that it is technically feasible and that the approach holds promise.

Возможности роботических технологий в лечении больных мышечно-инвазивным раком мочевого пузыря: робот-ассистированная цистэктомия

Introduction. The standardized incidence of bladder cancer (ВС) is 6,41 per 100,000 populations, and there is an upward trend. In 20-30% of patients, muscle-invasive BC (MIBC) is detected at the initial diagnosis. In 20% of patients with non-muscularly invasive BC (NMIBC), despite the treatment, muscle invasion is later detected. Radical cystectomy (RC) is considered to be the main method of treating MIBC. Due to the lack of large randomized trials to date evaluating the long-term oncological and functional results of open (ORC) and robot-assisted radical cystectomy (RARC), the question of choosing between these two surgical interventions remains open. In order to systematize the available research on this problem, we have made this literature review. Materials and methods. The search for relevant publications in the PubMed and e-library databases was carried out using the keywords robotic cystectomy , muscle-invasive bladder cancer , minimally invasive surgery , robot-assisted cystectomy , muscle-invasive blade cancer , mini-invasive surgery . As a result of the search, 83 sources were selected, which were included in this literature review. The analysis of the literature evaluated the criteria for selecting patients for robotic cystectomy, the features of their preoperative preparation, oncological results and complications of ORC and RARC, as well as the quality of life of patients after these surgical interventions and the economic aspects of their use. Results and discussion. The first RARC was performed in 2003 by M. Menon et al. The main advantages of RARC compared to ORC, proved as a result of the conducted studies, include lower intraoperative blood loss and the need for blood transfusion. There was no statistically significant difference between RARC and ORC in terms of the number and severity of complications, the radicality of surgery, the frequency of relapses and progression of BC, as well as the survival rate and quality of life of patients. The duration and cost of the ORC is less. Conclusions. The introduction of RARC into clinical practice allowed minimizing the trauma of access during ORC, eliminating the inconveniences of the laparoscopic approach, and optimizing the postoperative period. Further research is required on the following aspects of RARC: selection of patients for this surgical intervention, choice of the method of urine derivation during the operation, the possibility of using organ-sparing techniques and its economic feasibility.

Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

Introduction: We sought to describe the incidence, risk factors, and survival outcomes associated with pathologic upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). Methods: We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pathologic node positive (pN+) at final pathology analysis from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran-Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan-Meier curves were used to describe disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS). Results: A total of 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p < 0.01), more likely to have American Society of Anesthesiologists (ASA) score (≥3; 55% vs 44%, p = 0.04), and had higher rate of preoperative hydronephrosis (26% vs 10%, p < 0.01). They were more likely to have positive surgical margins (10% vs 3%, p = 0.01), recurrences (28% vs 9%, p < 0.01), and to receive adjuvant/salvage treatment (26% vs 3%, p < 0.01). On multivariate analysis, upstaging was associated with older age (odds ratio [OR] 1.04; confidence interval [CI] 1.01-1.07, p < 0.01), cT1 vs cTis (OR 4.25; CI 1.57-11.48, p < 0.01), cT1 vs cTa (OR 2.92; CI 1.40-6.06, p < 0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p < 0.01). Upstaged patients had worse 5-year RFS (53% vs 85%, log rank p < 0.01), DSS (66% vs 93%, log rank p < 0.01), and OS (49% vs 74%, log rank p < 0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p = 0.17). Conclusion: Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.

Is the use of ultra-low insufflation pressure safe and feasible in robot assisted radical prostatectomy.

Current innovations in minimally invasive surgery include using ultra-low insufflation pressure with the aim of improving peri-operative and short-term clinical outcomes. Despite an exponential increase in the use of robotic technology, there remains limited literature supporting the use of ultra-low pressure during robotic surgery. We performed a feasibility study of ultra-low-pressure robot-assisted laparoscopic radical prostatectomy (RARP). Prospective data related to standard pressure (15 mm Hg) RARP (Group 1) and ultra-low-pressure (6 mm Hg) RARP (Group 2) were collected and compared to assess the peri-operative and short-term outcomes. Outcome data of 112 consecutive patients (56 in each group) were collected. Mean age, pre-operative prostate specific antigen, body mass index, and performance status were similar in both groups. Mean console time was shorter in ultra-low-pressure RARP group (125 minutes) than in standard pressure RARP group (138 minutes) (p=0.016). Furthermore, there was no significant difference in console time or estimated blood loss between these 2 groups for patients with RARP and lymph node dissection. No patients from either group required conversion to an open procedure or received a peri-operative blood transfusion. None of the patients in either group developed post-operative complications or needed readmission. Our study has demonstrated that ultra-low-pressure RARP is a practical and safe option, and it supports the routine practice of ultra-low-pressure RARP with slow adaptation in other complex robotic surgeries, such as robotic cystectomy for bladder cancer.

Robot-Assisted Cystectomy and Ileal Conduit for Neurogenic Bladder: Comparison of Extracorporeal vs Intracorporeal Urinary Diversion

Objectives: The aim of the present study was to compare the perioperative outcomes of extracorporeal (EXTRA) vs intracorporeal (INTRA) urinary diversion in patients undergoing robotic cystectomy and ileal conduit for neurogenic bladder. Methods: All consecutive patients who underwent robot-assisted cystectomy and ileal conduit for neurogenic bladder in six centers between 2011 and 2020 were included in a retrospective study. Four centers performed exclusively INTRA urinary diversion all over the study period, one center performed exclusively EXTRA urinary diversion, and the last center performed EXTRA urinary diversion during a first period and INTRA during the subsequent period. Results: Ninety-seven patients were included: 66 in the EXTRA group and 31 in the INTRA group. There were 11 major (Clavien grade ≥3) postoperative complications in the overall population (11.3%) with no statistically significant difference between both groups (EXTRA = 12.1% vs INTRA = 9.7%; p = 0.99). The mean length of stay did not differ significantly between INTRA and EXTRA (13.1 vs 14.1 days; p = 0.44). The mean times to oral feeding and to return of bowel function were similar in the two groups (3.9 vs 3.5 days; p = 0.28 and 4.1 vs 4.1 days; p = 0.51, respectively). There was no incisional hernia in the INTRA group vs five in the EXTRA group (0% vs 7.6%; p = 0.17). Conclusion: The perioperative morbidity of robotic cystectomy and ileal conduit for neurogenic bladder appears to be relatively limited compared with the historical open series. Possibly due to the relatively small sample size, no difference was found between INTRA and EXTRA urinary diversion in terms of perioperative outcomes.

Radical Cystectomy in England from 2013 to 2019 on 12,644 patients: An analysis of national trends and comparison of surgical approaches using Hospital Episode Statistics data.

IntroductionWe evaluate the data of 12,644 Radical Cystectomies in England (Open, Robotic and Laparoscopic) with trends in the adaption of techniques and post‐operative complications.MethodsThis analysis utilised national Hospital Episode Statistics (HES) from NHS England.ResultsThere was a statistically significant increase (P < .001) in the number of Robotic assisted radical cystectomies from 10.8% in 2013‐2014 and 39.5% in 2018‐2019.The average LOS reduced from 12.3 to 10.8 days for RARC from 2013 to 2019 similarly the LOS reduced from 16.2 to 14.3 for ORC. The rate of sepsis (0‐90 days) did rise from 5% to 14.5% between 2013‐2014 and 2017‐2018 for the entire cohort (P < .001). Acute renal failure (ARF) increased over the years from 9.5% to 17% (P < .001). The rate for fever, UTI, critical care activity and ARF were higher for ORC than RARC (P < .001).The comparison of all episodes within 90 days for conduit versus non‐conduit diversions showed significantly higher rates of sepsis, infections, UTI and fever in non‐conduit group .Overall complications were significantly higher in non‐conduit group throughout the duration except was year 2016‐17(P < .001).The robotic approach has increased in last 5 years with nearly 40% of the cystectomies now being robotically in 2018‐19 from the initial percentage of 10.8% in 2013‐14.ConclusionThis evaluation of the HES data from NHS England for 12,644 RC confirms an increase in the adoption of Robotic Cystectomy. Our data confirms the need to develop strategies with enhanced recovery protocols and post‐operative close monitoring following Radical Cystectomy in order to reduce post‐operative complications.

Robotic cystectomy histopathology outcomes in patients who have ‘failed’ Bacillus Calmette–Guérin: A case series

Objective: Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time. Methods: A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B). Results: A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases. Conclusion: RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients. Level of evidence: Level 4.

Single-port robotic radical cystectomy with ileal conduit urinary diversion: technique and review of the early outcomes in literature

Single-port robotic radical cystectomy with ileal conduit urinary diversion: technique and review of the early outcomes in literature

The contemporary status of robotic intracorporeal neobladder

Robotic intracorporeal neobladder (RIN) is increasingly the modality of choice for intracorporeal urinary diversion in high-volume Robotic Urology centers. This article details the modern technique of RIN, explains specific tips and tricks to facilitate timely operative progression as well as weighs the outcomes from recently published series. An OVID/EMBASE database search was done using keywords: robotic, cystectomy, intracorporeal neobladder, orthotopic, and intracorporeal urinary diversion. The inclusion criteria were original studies on Robot-Assisted Radical Cystectomy (RARC) with RIN series, available in full text in English, published over the last ten years with a specific analysis of oncological and functional outcomes. Pooled data analysis of the 10 studies included shows 80% of patients had organ-confined disease (≤pT2), 1.86% of patients had positive surgical margin, median lymph node yield of 23 nodes (IQR = 7.5), and cancer-specific survival rate of 78% (range 72%-100%) over a mean follow up of 27.43 months (range 13-37 months). Functionally, the median day continence rate is 81.5%, night continence rate is 61%, and rate of return to spontaneous sexual activity is 33.5%. This compares favorably with outcomes of The International Robotic Cystectomy Consortium - Extracorporeal Urinary Diversion data and data from open radical cystectomy (ORC) neobladder series with long term follow up. High-volume robotic centers have successfully introduced programs for RARC, with RIN demonstrating its safety and feasibility. Their results suggest potential to improve perioperative and functional outcomes over ORC. Moreover, under mentorship, surgeons can learn the technique of RARC and RIN without these outcomes being significantly affected.

Review of the evidence for robotic-assisted robotic cystectomy and intra-corporeal urinary diversion in bladder cancer.

Radical cystectomy, pelvic lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. The surgery is both complex and highly morbid. Robotic cystectomy is now in its 16th year with established techniques and sufficient research maturity to enable comparison with its open counterpart. The present review focuses on the current evidence for robotic cystectomy and assesses various metrics including oncological, perioperative, functional, surgeon-specific and cost outcomes. The review also encapsulates the current evidence for intra-corporeal urinary diversion and its current status in the cystectomy arena.

Comparison of long-term outcomes in a 10-year experience of robotic cystectomy vs. open cystectomy.

To compare the outcomes of robotic-assisted (RARC) vs. open radical cystectomy (ORC) at a single academic institution. We retrospectively identified patients undergoing radical cystectomy for urothelial carcinoma of the bladder at our institution from 2007 to 2017. Data collected included age, sex, Body Mass Index (BMI), Charlson Age-Adjusted Comorbidity Index (CCI), final pathologic stage, surgical margins, lymph-node yield, estimated blood loss (EBL), 90-day complication rate, and length of stay (LOS). We evaluated overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox proportional hazard models were used to adjust for covariates. We identified 232 patients (73 RARC, 159 ORC) who underwent radical cystectomy. Patients who underwent RARC were older (71.8 vs. 67.5, p < 0.05) and had higher CCI scores (6.2 vs. 5.3, p < 0.05). In comparing perioperative outcomes, RARC patients had lower EBL (500 vs. 850, p < 0.01), lower blood transfusion rate (p < 0.01), and lower lymph-node yield (12 vs. 20, p < 0.01), and higher ICU admission rate (29% vs. 16% p < 0.01). There was no difference in BMI (p = 0.93), sex (p = 0.28), final pathological stage (p = 0.35), positive surgical margins (p = 0.47), complications (p = 0.58), or LOS (p = 0.34). Kaplan-Meier analysis showed no difference in OS (p = 0.26) or RFS (p = 0.86). There was no difference in restricted mean survival time for OS (53 vs. 56months, p = 0.81) or for RFS (65 vs. 64months, p = 0.90). Cox multivariate regression models showed that surgical approach does not have a significant impact on OS (p = 0.46) or RFS (p = 0.35). Our study indicates that in our 10-year experience, patients undergoing there was no difference between RARC and ORC patients with respect to OS and RFS despite being older and having more comorbidities. Our work supports the importance of patient selection to optimize outcomes.

PE16 - Robotic cystectomy histopathology outcomes in patients whom have ‘failed’ BCG

PE16 - Robotic cystectomy histopathology outcomes in patients whom have ‘failed’ BCG