Excerpt
As the utilization of the robotic platform gains momentum in managing various urologic pathologies, its application to bladder surgery continues to evolve. Traditionally, open radical cystectomy with bilateral pelvic node dissection and urinary diversion has been the standard of care for managing muscle-invasive and select high-risk nonmuscle-invasive bladder cancer. However, robotic radical cystectomy has emerged as a minimally invasive surgical technique for managing these conditions and reducing surgical morbidity for advanced localized bladder cancer without compromising oncologic outcomes. Since the first documented case series on robotic cystectomy in 2003, the utilization of this approach has been gradually gaining popularity. Despite its technical challenges, long learning curve, and longer operating times, robotic radical cystectomy has been associated with several benefits compared to open radical cystectomy. These include less intraoperative blood loss, reduced need for transfusions, fewer major postoperative complications, a lower rate of positive surgical margins, 40% more lymph nodes recovered on average, and earlier hospital discharge. In addition, robotic surgery also offers a reduced risk of wound-related complications and thromboembolic events. Quality of life scores are generally similar between the robotic and open surgical approaches, but when the robotic intracorporeal urinary diversion was added, quality of life scores improved. Comparative studies have demonstrated that oncological outcomes are comparable between open and robotic surgical approaches to radical cystectomy over 10 years with regard to recurrence-free, progression-free, and overall survival. Given its potential value, long learning curve, high technical complexity, and limitations, the role of minimally invasive major robotic bladder surgery continues to evolve and is the subject of ongoing investigation and study.
Sections
- Introduction
- Anatomy and Physiology
- Indications
- Contraindications
- Equipment
- Personnel
- Preparation
- Technique or Treatment
- Complications
- Clinical Significance
- Enhancing Healthcare Team Outcomes
- Nursing, Allied Health, and Interprofessional Team Interventions
- Review Questions
- References
0000 [Epub]
Matthew Lee, Daniel D. Eun
Temple University Hospital, Temple University School of Medicine, Philadelphia, PA