Robot Assisted Laparoscopic Radical Cystectomy

Three-dimensional stereoscopic vision, and multiangled movement with endowrist instruments are advantages for robotic-assisted surgery, although they are cost-intensive tools available in specialized centers alone.

In 2003, the first case report of daVinci-assisted laparoscopic cystectomy with intracorporeally created ileal neobladder (Hautmann) was described by Beecken et al., resulting in operative time of 8.5 hours (20).

The feasibility of robot-assisted laparoscopic cystectomy with intracorporeal created ileal conduit was reported in two men and one woman by Balaji et al., although mean operative time was more than 10 hours (691 minutes); mean estimated blood loss,

250 mL; and hospital stay, 7.3 days (21). Menon et al. reported technical feasibility of nerve-sparing robot-assisted radical cystectomy with extracorporeally created urinary diversion in 14 men and 3 women (22). Mean blood loss was less than 150 mL, and operative time for robotic radical cystectomy, extracorporeal ileal conduit, and extracorporeal orthotopic neobladder were 140, 120, and 168 minutes, respectively, although 13 (76%) patients had associated bilharziasis, with significant periureteric, perivesicular, and perivesical scarring. The functional and oncological data in this series were awaited.

The authors concluded that laparoscopic-assisted approach contributes to decreased postoperative pain and quicker recovery with similar complication rate to open approach. It should be noted that in this study, the reconstructive portion was performed through a 15-cm low Pfannenstiel incision.

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