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Robotic-Assisted Radical Cystectomy

  • Granville L. LloydEmail author
  • Janet E. Baack Kukreja
Chapter

Abstract

Robotically-assisted radical cystectomy (RARC) is an exciting application of the robotic surgical platform whose role continues to evolve. Importantly, over a decade into widespread usage, its usage is associated with outcomes that are clearly non-inferior to open radical cystectomy (ORC). Many different outcomes have been reported regarding potential benefits and costs with the robotically-assisted approach, but two factors have been consistent: blood loss is lower, and operative times are longer for RARC as compared to ORC. In some centers outcomes and length of stay appear to favor the robotic approach, but in other centers of excellence no benefit has been demonstrated when compared with well-executed, high-volume open cystectomy. That said, we are aware of no recent series that shows RARC to result in inferior oncologic or quality-associated outcomes such as length of stay or complication rate when compared to ORC. The learning curve, especially for surgeons familiar with the robotic platform, appears to require 20–30 cases to generate excellent outcomes. Costs are largely associated with avoidance of complications; as familiarity grows and technique is refined, the benefits of lower blood loss and decreased fluid shifts may ultimately result in measurably better outcomes and lower overall cost. No prospective series to date has compared a surgical arm performing robotic intracorporeal diversion to open surgery, although early data suggests a possible benefit.

Keywords

Cystectomy Bladder neoplasm Urinary diversion Laparoscopy 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyRocky Mountain Regional Veterans Hospital, University of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Division of Urology, Department of SurgeryUniversity of ColoradoAuroraUSA

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