Robot-assisted radical cystectomy and urinary diversion

Robot-assisted radical cystoprostatectomy in the post-radiation and chemotherapy patient

We report a case of successful salvage radical cystoprostatectomy (RRCP) on a patient with recurrent high-grade T2 transitional cell carcinoma following external-beam radiation and systemic chemotherapy. The effect on tissue planes and the resulting adhesions after external radiation are well-known. While RRCPs have been successfully completed in many academic centers, there have been no reports of using this approach for salvage cystectomy after radiation. The RRCP was performed without complications, and was followed by an extended bilateral pelvic lymph node dissection and creation of an ileal conduit via the midline extraction incision.

Robot-assisted laparoscopic radical cystectomy: initial experience on 27 consecutive patients

Recent reports have demonstrated that robot-assisted laparoscopic cystectomy is technically feasible. We report technical and functional results of a large series of patients undergoing laparoscopic cystectomy with the da Vinci surgical system (DVSS). A total of 27 patients (24 males) underwent laparoscopic radical cystectomy with the DVSS (intuitive surgical) between January 2004 and December 2005. Indications for cystectomy were muscle-invasive transitional cell carcinoma (TCC) or leiomyosarcoma of the urinary bladder (n = 24) and bladder shrinking following prior radiotherapy for TCC. A pelvic lymphadenectomy was a routine part of the procedure. Urinary diversions were ilieal conduits (n = 19) and ileal neobladders (n = 8). Mean operating time was 340 min (range 150-450) with a mean blood loss of 301 ml (range 50-550). The mean number of lymph nodes retrieved during lymphadenectomy was 23. Surgical margins were negative except in one case. After a mean follow-up of 10.2 months, two perioperative (anastomotic leakage, adhesions) and three postoperative complications (ileus, intestinal fistula, urinary tract obstruction) occurred. Six out of seven patients reported satisfying erectile function following nerve-sparing surgery. Day-time continence was completely restored after a mean 3.5 months in seven of eight patients. Robot-assisted laparoscopic cystectomy is a safe procedure. Satisfying functional and oncological short-term results can be achieved within acceptable operating time limits.

Radical cystectomy and lymphadenectomy for invasive bladder cancer: towards the evolution of an optimal surgical standard

The surgical management of invasive bladder cancer has undergone a significant evolution in technique since its initial introduction. Changes in the extent of surgery have largely reflected a better understanding of the natural history of bladder cancer and the recognized pathways of progression. Incorporation of contemporary surgical techniques that target the perivesical soft tissues, regional lymph nodes, and adjacent organs appear to enhance oncologic outcomes. A growing body of evidence indicates that the quality of radical cystectomy (RC) directly affects patient outcome. Recently, quality of life and functional considerations have led to surgical modifications such as nerve-, prostate-, vaginal wall-, and urethra-sparing approaches. While some modifications in appropriate candidates appear not to decrease cancer control, further studies will be needed to establish their role and safety. This ongoing evolution in the technique of RC and pelvic lymph node dissection (PLND) may help define a new surgical standard that provides optimal benefit in patients with invasive bladder cancer.

[Radical laparoscopic cystectomy]

Radical laparoscopic cystectomy is being adopted by most groups with proven experience in laparoscopic surgery, especially by those who have already completed the learning curves in radical laparoscopic prostatectomy. It is still considered a highly complex technique, which has not yet been mastered in many Urology Units. In this article, we review the surgical technique and available literature on this approach, with special emphasis on its indications, advantages and most frequent morbidity.

Status of robotic cystectomy in 2005

Minimally invasive approaches have been shown to offer considerable benefits to patients in the treatment of urologic malignancies. While open radical cystectomy remains the gold standard for the treatment of muscle invasive bladder cancer, the continued refinement of laparoscopic techniques and the success of robotic assistance in radical prostatectomy have led to great interest in minimally invasive approaches to radical cystectomy. We review the current experience with laparoscopic and robotic radical cystectomy and its role in the treatment of muscle invasive bladder cancer.