Robotic-Assisted Radical Cystectomy
Robotic-Assisted Radical Cystectomy
Robotic radical cystectomy is a reasonable minimally invasive modality for the treatment of invasive bladder cancer. Although more costly, its main advantage is the decreased blood loss and potential LOS compared with open surgery. Radical cystectomy is a morbid operation, mainly due to the length of the procedure, the blood loss and the massive fluid shifts that occur with volume resuscitation. The lower blood loss with robotic cystectomy coupled with less significant losses and thus markedly less fluid shifts provide for a potentially safer operation for patients. In experienced hands, robotic cystectomy can be completed expeditiously without manual bowel retraction. Therefore, urinary diversion is aided by less edematous bowel, which can lead to faster return of bowel function and thus a decreased LOS.
The procedure is best performed by a high-volume urologic oncology surgeon with extensive robotic experience (especially prostatectomy), who is also adept at performing radical cystectomy in both the male and female patient. It is therefore best to initiate one's learning curve by first performing robotic cystectomy in male patients, after a reasonable level of robotic prostatectomy experience. As the learning curve is negotiated, female cystectomy can also be easily incorporated into the armamentarium. As with most major procedures that are routinely performed at an academic center, instituting clinical care pathways are crucial to expedite hospital discharge, and decrease cost, LOS and, most importantly, short- and long-term complications.
Expert Commentary
Robotic radical cystectomy is a reasonable minimally invasive modality for the treatment of invasive bladder cancer. Although more costly, its main advantage is the decreased blood loss and potential LOS compared with open surgery. Radical cystectomy is a morbid operation, mainly due to the length of the procedure, the blood loss and the massive fluid shifts that occur with volume resuscitation. The lower blood loss with robotic cystectomy coupled with less significant losses and thus markedly less fluid shifts provide for a potentially safer operation for patients. In experienced hands, robotic cystectomy can be completed expeditiously without manual bowel retraction. Therefore, urinary diversion is aided by less edematous bowel, which can lead to faster return of bowel function and thus a decreased LOS.
The procedure is best performed by a high-volume urologic oncology surgeon with extensive robotic experience (especially prostatectomy), who is also adept at performing radical cystectomy in both the male and female patient. It is therefore best to initiate one's learning curve by first performing robotic cystectomy in male patients, after a reasonable level of robotic prostatectomy experience. As the learning curve is negotiated, female cystectomy can also be easily incorporated into the armamentarium. As with most major procedures that are routinely performed at an academic center, instituting clinical care pathways are crucial to expedite hospital discharge, and decrease cost, LOS and, most importantly, short- and long-term complications.
