Search

Purpose of Review: Radical cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years., Recent Findings: Prospective evaluations of open (ORC) and robot-assisted radical cystectomy (RARC) are emerging. The radical cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracorporeal reconstruction. The trial confirmed prospective randomized comparisons are possible, and replicates observations from two earlier, smaller randomised controlled trials with longer follow-up. Although there has been significant traction to the intracorporeal approach to RARC, randomized trial evidence is awaited to show any benefit over ORC., Summary: New evidence alludes to the noninferiority of the robotic platform in radical cystectomy in comparison to open surgery. There is minimal evidence of a clinically meaningful benefit. Until this is addressed, ORC remains the gold standard for the definitive surgical management of bladder cancer.

We performed a systematic literature review to assess the current status of a totally intracorporeal robot-assisted radical cystectomy (RARC) approach. The current 'gold standard' for radical cystectomy remains open radical cystectomy. RARC has lagged behind robot-assisted prostatectomy in terms of adoption and perceived patient benefit, but there are indications that this is now changing. There have been several recently published large series of RARC, both with extracorporeal and with intracorporeal urinary diversions. The present review focuses on the totally intracorporeal approach. Radical cystectomy is complex surgery with several important outcome measures, including oncological and functional outcomes, complication rates, patient recovery and cost implications. We aim to answer the question of whether there are advantages to a totally intracorporeal robotic approach or whether we are simply making an already complex procedure more challenging with an associated increase in complication rates. We review the current status of both oncological and functional outcomes of totally intracorporeal RARC compared with standard RARC with extraperitoneal urinary diversion and with open radical cystectomy, and assess the associated short- and long-term complication rates. We also review aspects in training and research that have affected the uptake of RARC. Additionally we evaluate how current technology is contributing to the future development of this surgical technique., (© 2013 The Authors. BJU International © 2013 BJU International.)

Background: Robotic technology disseminated into urological practice without robust comparative effectiveness data., Objective: To review the diffusion of robotic surgery into urological practice., Methods: We performed a comprehensive literature review focusing on diffusion patterns, patient safety, learning curves, and comparative costs for robotic radical prostatectomy, partial nephrectomy, and radical cystectomy., Results: Robotic urologic surgery diffused in patterns typical of novel technology spreading among practicing surgeons. Robust evidence-based data comparing outcomes of robotic to open surgery were sparse. Although initial Level 3 evidence for robotic prostatectomy observed complication outcomes similar to open prostatectomy, subsequent population-based Level 2 evidence noted an increased prevalence of adverse patient safety events and genitourinary complications among robotic patients during the early years of diffusion. Level 2 evidence indicated comparable to improved patient safety outcomes for robotic compared to open partial nephrectomy and cystectomy. Learning curve recommendations for robotic urologic surgery have drawn exclusively on Level 4 evidence and subjective, non-validated metrics. The minimum number of cases required to achieve competency for robotic prostatectomy has increased to unrealistically high levels. Most comparative cost-analyses have demonstrated that robotic surgery is significantly more expensive than open or laparoscopic surgery., Conclusions: Evidence-based data are limited but suggest an increased prevalence of adverse patient safety events for robotic prostatectomy early in the national diffusion period. Learning curves for robotic urologic surgery are subjective and based on non-validated metrics. The urological community should develop rigorous, evidence-based processes by which future technological innovations may diffuse in an organized and safe manner.

Purpose of Review: Minimally invasive surgeries such as conventional laparoscopic surgery and robotic assisted laparoscopic surgery (RALS) have significant advantages over the traditional open surgical approach including lower pain medication requirements and decreased length of hospitalization. However, open surgery has demonstrated better success rates and shorter surgery time when compared to the other modalities. Currently, it is unclear which approach has better long-term clinical outcomes, greater benefits and less cost., Recent Findings: There are limited studies in the literature comparing these three different surgical approaches. In this review, we will evaluate the advantages and disadvantages of RALS compared to conventional laparoscopic surgery and open surgery for commonly performed pediatric urological procedures such as pyeloplasty, ureteral reimplantation, complete and partial nephrectomy, bladder augmentation and creation of continent catheterizable channels., Summary: Although it is not yet possible to demonstrate the superiority of one single surgical modality over another, RALS has been shown to be feasible, well tolerated and advantageous in reconstructive urological procedures. With experience, the outcomes of RALS are improving, justifying its usage. However, cost remains a significant issue, limiting the accessibility of RALS, which in the future may improve with market competition and device innovation.

Surgeon controlled robot-assisted laparoscopic radical cystectomy (RARC) is becoming a viable treatment option for patients with muscle-invasive bladder cancer. There are currently several single-institution reports and a few multi-institutional reports on operative, perioperative, and intermediate-term oncologic outcomes for RARC. While the data appears promising, there is currently no long term oncologic outcomes for RARC. Long-term oncologic outcomes for RARC should be forthcoming in the near future. As the technology improves, and surgeons become more proficient at RARC, the cost effectiveness of RARC should surpass open radical cystectomy. The goal of this article is to review the most recent developments within the past 1 to 2 years surrounding RARC, including important technical advances for performing this operation, current data on oncologic outcomes, and the future direction of RARC.

Although the technical feasibility of laparoscopic radical cystectomy (LRC) has been proven and the procedure has been accepted in the EAU guidelines 2011 as a valid alternative, its actual position has to be determined. On the one hand the advantages of LRC (less blood loss, lower transfusion rates, shorter analgesia time) have been proven in retrospective studies; however, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times and in cases of a laparoscopic-assisted creation of a neobladder, the question of the advantage of this approach remains doubtful. Despite case reports of port metastases and peritoneal carcinosis following laparoscopic and robot-assisted radical cystectomy, there is no difference in terms of oncological long-term data (up to 10 years) between laparoscopy and open surgery performed at centres of excellence. Evidently, the curative options for the patients do not depend on the type of surgery (open versus minimally invasive) but on the efficacy of adjuvant treatment strategies (polychemotherapy). Currently it is believed that LRC should be considered for patients with low risk of progression (pT1-2). The final position of laparoscopic radical cystectomy can only be evaluated in a multicentric randomized controlled trial.

The standard therapy for muscle invasive bladder cancer is radical cystectomy and urinary diversion. For open surgery this procedure has notable perioperative morbidity. Performing laparoscopic cystectomy can reduce this morbidity. So far it remains unclear, whether the oncologic outcome of the laparoscopic approach is comparable to open surgery or not due to a lack of long-term follow-up data. Important surgical steps, such as extended lymphadenectomy, sparing of the neurovascular bundle for preservation of potency, preparation of the urethra for orthotopic neobladder and intracorporeal construction of a urinary diversion can be achieved much more easily with a robot-assisted approach than with conventional laparoscopy. Furthermore, the learning curve for robot-assisted cystectomy is much steeper. Therefore, if a laparoscopic cystectomy is performed, it should be performed using a robot-assisted approach.

Purpose of Review: The prevalence of robot-assisted radical cystectomy is steadily increasing. We review the recent literature evaluating this technique as a minimally invasive alternative to open radical cystectomy for the treatment of bladder cancer., Recent Findings: Within the last year, numerous robot-assisted radical cystectomy case series with larger cohorts have been published, providing new insights regarding perioperative morbidity and early oncologic outcomes. With appropriate experience, this procedure offers the potential benefits of decreased blood loss and transfusion rates, reduced analgesic requirements, and shorter hospital stay relative to the open approach. Recent data from a nonrandomized study demonstrate fewer postoperative complications with robot-assisted radical cystectomy. Short-term oncologic outcomes in the absence of patient selection appear to be equivalent to contemporary open radical cystectomy series. A small prospective, randomized trial comparing open and robotic radical cystectomy demonstrated equivalent lymph node yields., Summary: Robot-assisted radical cystectomy is an emerging minimally invasive approach to radical cystectomy. Early data suggest potential benefits in perioperative morbidity with equivalent short-term oncologic outcomes as compared with open radical cystectomy. Long-term follow-up and larger prospective, randomized comparisons with open radical cystectomy are needed as this technique continues to be evaluated.

While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non-muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade. The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy. While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up. This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.

Objectives: To review the current status and role of robot-assisted laparoscopic pelvic lymphadenectomy. To review the need, extent, lymph node yield, oncological feasibility, and outcome of robot-assisted pelvic lymphadenectomy for invasive bladder cancer in patients undergoing a robot-assisted laparoscopic radical cystectomy., Methods: The National Library of Medicine and the Pub Med were extensively searched for the cases of robot-assisted laparoscopic pelvic lymphadenectomy performed in conjunction with robot-assisted laparoscopic radical cystectomy for bladder cancer using the following keywords: bladder cancer, pelvic lymphadenectomy, cystectomy, laparoscopy, robot, and robot-assisted radical cystectomy. These were reviewed and analyzed (using certain tabulated parameters) to determine the current status of robot-assisted pelvic lymphadenectomy., Results: The search yielded about 12 major published series (278 cases) of "robot-assisted radical cystectomy with pelvic lymphadenectomy," with an overall acceptable mean operating time(s), complication rate, blood loss, and hospital stay., Conclusions: Robot-assisted laparoscopic pelvic lymphadenectomy in conjunction with robot-assisted laparoscopic radical cystectomy is an oncologically feasible and technically safe procedure with acceptable early operative outcomes that appear to be comparable to those achieved with open/laparoscopic surgery., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Purpose of Review: Robot-assisted radical cystectomy (RARC) continues to provide a minimally invasive option to the management of bladder cancer. Its utilization appears to be steadily increasing. The purpose of this paper is to review recent advances and outcomes related to robot-assisted radical cystectomy., Recent Findings: There are an increasing number of publications and abstracts related to robot-assisted radical cystectomy. In a majority of these case series, the urinary diversion is performed extracorporeally due to improved operative times. There has been some larger series published within the last year, which have provided some meaningful insight into the perioperative and oncologic issues related to the procedure. Several of these reports have provided a retrospective comparison to open radical cystectomy. In experienced hands, this procedure can be accomplished in a reasonable amount of time with appropriate pathologic outcomes, whereas providing decreased complication rates, EBL, and transfusion rates as well as improved convalescence compared with open-radical cystectomy. Although no long-term survival data exists to date, intermediate-term follow-up is beginning to emerge and appears similar to open-radical cystectomy in nonrandomized comparisons., Summary: Robot-assisted radical cystectomy is a reproducible, minimally invasive approach to radical cystectomy. Patients appear to derive benefit from this approach in regards to complications and convalescence without evidence of compromise to early and intermediate oncological outcomes. Long-term oncologic follow-up and, ideally, randomized prospective comparisons to open radical cystectomy are needed to further validate this procedure.