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Robotic Radical Cystectomy
Cory Harris, MD, Serge Ginzburg, MD, Joseph R. Wagner, MD.
Hartford Hospital, Hartford, CT, USA.

BACKGROUND: Radical prostatectomy is now the most commonly performed robotic procedure. Radical cystectomy has several similar features to radical prostatectomy including anatomic location, an element of reconstruction, and the potential for even more morbidity. We present our experience with robotic radical cystectomy.
METHODS: We performed 53 robotic radical cystectomies with urinary diversion utilizing the da Vinci surgical system between February, 2003 and March, 2010. Urinary diversion for ileal loop and Indiana Pouch was performed through a mini-incision after laparoscopic bowel mobilization For neobladder, the urethral anastomosis was performed robotically or through an incision at the surgeon's discretion. Cystoscopy, laparoscopic bowel mobilization, and laparoscopic nephrectomy were all included in total OR times. Demographics, operative data, pathology, and complications were reviewed.
RESULTS: Average patient age was 65 (median 66 with range 20-87); 9 were women and 44 were men. Average robotic time was 195 minutes (range 107-334 minutes). Total OR time was 426 minutes (range 293-579 minutes). 3 patients underwent concurrent unilateral or bilateral laparoscopic nephroureterectomy. The average number of nodes removed was 18 (range 10-37). 13 patients (25%) had positive nodes. Final pathology showed 3 patients T0, 6 patients Tis, 8 patients T1, 11 patients T2, 11 patients T3, and 12 patients T4. There were 2 positive surgical margins. 2 patients had benign indications for surgery (chronic cystitis/neurogenic bladder and cystitis glandularis/neurogenic bladder). 12 patients experienced 14 complications. There were 4 Clavien Grade 1, 3 Clavien Grade 2, 2 Clavien Grade 3a, 3 Clavien Grade 3b, 1 Clavien Grade 4a, and 1 Clavien Grade 5 complications.
CONCLUSIONS: Robotic radical cystectomy can be performed with operative, pathologic, and complication outcomes similar to open cohorts.


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