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Total intracorporeal robotic cystectomy: are we there yet?
MedLine Citation:
PMID:  23357930     Owner:  NLM     Status:  In-Data-Review    
PURPOSE OF REVIEW: To provide discussion on several recently published case series describing complete intracorporeal robotic cystectomy. Are we making a complex and expensive procedure more challenging or are there patient benefits to be realized from a complete minimally invasive approach? We discuss how effective and cost-efficient a complete intracorporeal approach is, review the updates and comment on the future direction of robot-assisted radical cystectomy (RARC).
RECENT FINDINGS: Several centers have recently reported a series of RARC with intracorporeal urinary diversion. Baseline demographics, complication rates and oncological outcome data were comparable to previously published open radical cystectomy series, as well as robotic cystectomy with extracorporeal urinary diversion series. In centers experienced in robotics, comparable outcomes were achieved early in the series with no significant difference in lymph node yields, positive surgical margin rates or complication rates. However, operation times and patient's length of stay (LOS) continued to improve, suggesting that aspect of the learning curve is longer than previously thought. Benefits such as decreased blood loss and reduced LOS, commonly associated with minimally invasive surgery, were seen and while costs of RARC remain prohibitive, reducing operative times and LOS will improve cost analysis.
SUMMARY: RARC with totally intracorporeal urinary diversion is technically feasible with good early and intermediate-term oncological and complication rate results. High-volume centers with expertise can deliver a complete intracorporeal robotic cystectomy with no increase in the complication rates or additional costs compared to RARC with extracorporeal urinary diversion. Further long-term oncological and functional data and the results of prospective randomized controlled trials are both pending to confirm these findings.
Justin W Collins; Peter N Wiklund; Mihir M Desai; Alvin C Goh; Inderbir S Gill
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in urology     Volume:  23     ISSN:  1473-6586     ISO Abbreviation:  Curr Opin Urol     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-01-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200621     Medline TA:  Curr Opin Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  135-40     Citation Subset:  IM    
aSection of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden bUSC Institute of Urology, Hillard and Roclyn Center for Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California cDepartment of Urology, The Methodist Hospital, Houston, Texas, USA.
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