Our technigue of robot-assisted radical cystectomy in women

Summary

Introduction: Radical cystectomy is a standard method in treating invasive bladder cancer. With the development of minimally invasive techniques, robot-assisted procedures are coming to the fore in numerous surgical approaches, which is also the case for a number of urological, predominantly challenging oncological procedures. These also include radical cystectomy.

Material and methods: A video is presented of a 43-year-old female patient with muscle-invasive bladder cancer (histologically with a sarcomatoid component) undergoing surgery. Robot-assisted radical cystectomy in women (anterior exenteration) is performed using the latest generation DaVinci Xi robot. The procedure consists of three fundamental phases:

1. the phase of extended pelvic lymph node dissection;

2. the resection phase – cystectomy, hysterectomy, adnexectomy, and anterior vaginal wall resection;

3. the reconstruction phase – in this case, complete intracorporeal orthotopic neobladder construction according to Studer.

Results: Duration of procedure 475 minutes, blood loss 600 ml.

Histologically: sarcomatoid urothelial carcinoma pT2a pN0 (21 negative nodes), R0 resection

Complications: bowel paralysis postoperatively; a nasogastric tube inserted temporarily. She was discharged on postoperative day 15.

Conclusion: Radical cystectomy is a challenging procedure burdened with high morbidity and even mortality, and the quality of surgical performance is essential and critical for its outcome. Robot-assisted radical cystectomy is, in most parameters, fully comparable with open radical cystectomy. And it is the potential reduction in morbidity and improved recovery period that is the main benefit of robotic surgery. Based on the literature, other advantages should be lower blood loss, less need for blood transfusions, and shorter length of hospital stay. Disadvantages particularly include longer operative time and higher costs. Robot-assisted radical cystectomy is a safe procedure comparable with open cystectomy, particularly in terms of oncological outcomes, while having a number of benefits as well as disadvantages. However, it is particularly true that the choice of method does not affect the outcomes as significantly as does the quality of the surgeon.

Keywords:

robotic surgery – Bladder cancer – radical cystectomy