Robot-Assisted Radical Cystectomy Versus Open Radical Cystectomy

  • Vivek Venkatramani
  • Dipen J. ParekhEmail author


Radical cystectomy is suited to a minimally invasive approach, and robotic surgery holds the potential for improving perioperative morbidity compared with open surgery, without a compromise of oncological efficacy. Recent meta-analyses have shown that minimally invasive cystectomy is associated with lower morbidity, shorter length of stay, reduced blood loss and transfusion rates, less post-operative ileus and a reduced need for analgesics. The short and medium term oncological efficacy of robotic cystectomy has been shown to be equivalent to open surgery. However, larger studies with longer follow-up are needed in order to obtain higher levels of evidence.


Radical cystectomy Minimally invasive Robotic surgery Complications Surgical margins Lymphadenectomy Oncological outcomes Quality of life Functional outcomes Recurrence patterns 


  1. 1.
    Huang GJ, Stein JP. Open radical cystectomy with lymphadenectomy remains the treatment of choice for invasive bladder cancer. Curr Opin Urol. 2007;17(5):369–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Novotny V, Hakenberg OW, Wiessner D, Heberling U, Litz RJ, Oehlschlaeger S, et al. Perioperative complications of radical cystectomy in a contemporary series. Eur Urol. 2007;51(2):397–401. discussion 401–2PubMedCrossRefGoogle Scholar
  3. 3.
    Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67(3):376–401.PubMedCrossRefGoogle Scholar
  4. 4.
    Luchey AM, Agarwal G, Poch MA. Robotic-assisted radical cystectomy. Cancer control. J Moffitt Cancer Cent. 2015;22(3):301–6.Google Scholar
  5. 5.
    Xia L, Wang X, Xu T, Zhang X, Zhu Z, Qin L, et al. Robotic versus open radical cystectomy: an updated systematic review and meta-analysis. PLoS One. 2015;10(3):e0121032.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A, et al. Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67(3):402–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Raza SJ, Wilson T, Peabody JO, Wiklund P, Scherr DS, Al-Daghmin A, et al. Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2015;68(4):721–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Snow-Lisy DC, Campbell SC, Gill IS, Hernandez AV, Fergany A, Kaouk J, et al. Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes. Eur Urol. 2014;65(1):193–200.PubMedCrossRefGoogle Scholar
  9. 9.
    Parekh DJ, Messer J, Fitzgerald J, Ercole B, Svatek R. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189(2):474–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67(6):1042–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57(2):196–201.PubMedCrossRefGoogle Scholar
  12. 12.
    Sánchez de Badajoz E, Gallego Perales JL, Reche Rosado A, de la Cruz JM G, Jiménez Garrido A. Radical cystectomy and laparoscopic ileal conduit. Arch Esp Urol. 1993;46(7):621–4.PubMedGoogle Scholar
  13. 13.
    Gill IS, Fergany A, Klein EA, Kaouk JH, Sung GT, Meraney AM, et al. Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology. 2000;56(1):26–9; discussion 29–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Gill IS, Kaouk JH, Meraney AM, Desai MM, Ulchaker JC, Klein EA, et al. Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience. J Urol. 2002;168(1):13–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, El-Tabey NA, et al. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003;92(3):232–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Yohannes P, Puri V, Yi B, Khan AK, Sudan R. Laparoscopy-assisted robotic radical cystoprostatectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer: initial two cases. J Endourol Endourol Soc. 2003;17(9):729–32.CrossRefGoogle Scholar
  17. 17.
    Beecken W-D, Wolfram M, Engl T, Bentas W, Probst M, Blaheta R, et al. Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol. 2003;44(3):337–9.CrossRefGoogle Scholar
  18. 18.
    Satyanarayana R, Kallingal G, Parekh D. Current status of robotic and laparoscopic techniques in radical cystectomy and diversion procedures for bladder cancer: review. Minerva Urol E Nefrol Ital J Urol Nephrol. 2014;66(1):1–14.Google Scholar
  19. 19.
    Yu H, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Nguyen PL, Choueiri TK, et al. Comparative analysis of outcomes and costs following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: results from the US Nationwide Inpatient Sample. Eur Urol. 2012;61(6):1239–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Ishii H, Rai BP, Stolzenburg J-U, Bose P, Chlosta PL, Somani BK, et al. Robotic or open radical cystectomy, which is safer? A systematic review and meta-analysis of comparative studies. J Endourol Endourol Soc. 2014;28(10):1215–23.CrossRefGoogle Scholar
  21. 21.
    Hayn MH, Hussain A, Mansour AM, Andrews PE, Carpentier P, Castle E, et al. The learning curve of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2010;58(2):197–202.PubMedCrossRefGoogle Scholar
  22. 22.
    Pruthi RS, Smith A, Wallen EM. Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy. J Endourol Endourol Soc. 2008;22(11):2469–74.CrossRefGoogle Scholar
  23. 23.
    Guru KA, Wilding GE, Piacente P, Thompson J, Deng W, Kim HL, et al. Robot-assisted radical cystectomy versus open radical cystectomy: assessment of postoperative pain. Can J Urol. 2007;14(6):3753–6.PubMedGoogle Scholar
  24. 24.
    Leow JJ, Reese SW, Jiang W, Lipsitz SR, Bellmunt J, Trinh Q-D, et al. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol. 2014;66(3):569–76.PubMedCrossRefGoogle Scholar
  25. 25.
    Ishii Y, Itoh N, Takahashi A, Masumori N, Ikeda T, Tsukamoto T. Bladder cancer discovered by ovarian metastasis: cytokeratin expression is useful when making differential diagnosis. Int J Urol Off J Jpn Urol Assoc. 2005;12(1):104–7.Google Scholar
  26. 26.
    Tang K, Xia D, Li H, Guan W, Guo X, Hu Z, et al. Robotic vs. open radical cystectomy in bladder cancer: a systematic review and meta-analysis. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2014;40(11):1399–411.Google Scholar
  27. 27.
    Hellenthal NJ, Hussain A, Andrews PE, Carpentier P, Castle E, Dasgupta P, et al. Lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. BJU Int. 2011;107(4):642–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Khan MS, Elhage O, Challacombe B, Murphy D, Coker B, Rimington P, et al. Long-term outcomes of robot-assisted radical cystectomy for bladder cancer. Eur Urol. 2013;64(2):219–24.PubMedCrossRefGoogle Scholar
  29. 29.
    Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot. 2010;6(3):315–23.PubMedCrossRefGoogle Scholar
  30. 30.
    Kauffman EC, Ng CK, Lee MM, Otto BJ, Wang GJ, Scherr DS. Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int. 2011;107(4):628–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Martin AD, Nunez RN, Pacelli A, Woods ME, Davis R, Thomas R, et al. Robot-assisted radical cystectomy: Intermediate survival results at a mean follow-up of 25 months. BJU Int. 2010;105(12):1706–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Mmeje CO, Nunez-Nateras R, Nielsen ME, Pruthi RS, Smith A, Wallen EM, et al. Oncologic outcomes for lymph node-positive urothelial carcinoma patients treated with robot assisted radical cystectomy: with mean follow-up of 3.5 years. Urol Oncol Semin Orig Investig. 2013;31(8):1621–7.CrossRefGoogle Scholar
  33. 33.
    Nazmy M, Yuh B, Kawachi M, Lau CS, Linehan J, Ruel NH, et al. Early and late complications of robot-assisted radical cystectomy: a standardized analysis by urinary diversion type. J Urol. 2014;191(3):681–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Xylinas E, Green DA, Otto B, Jamzadeh A, Kluth L, Lee RK, et al. Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years. Urology. 2013;82(6):1323–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Yuh B, Torrey RR, Ruel NH, Wittig K, Tobis S, Linehan J, et al. Intermediate-term oncologic outcomes of robot-assisted radical cystectomy for urothelial carcinoma. J Endourol. 2014;28(8):939–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Raza SJ, Al-Daghmin A, Zhuo S, Mehboob Z, Wang K, Wilding G, et al. Oncologic outcomes following robot-assisted radical cystectomy with minimum 5-year follow-up: the Roswell Park cancer Institute experience. Eur Urol. 2014;66(5):920–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Khan MS, Challacombe B, Elhage O, Rimington P, Coker B, Murphy D, et al. A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy. Int J Clin Pract. 2012;66(7):656–62.PubMedCrossRefGoogle Scholar
  38. 38.
    Nepple KG, Strope SA, Grubb RL III, Kibel AS. Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer. Urol Oncol Semin Orig Investig. 2013;31(6):894–8.CrossRefGoogle Scholar
  39. 39.
    Gandaglia G, De Groote R, Geurts N, D’Hondt F, Montorsi F, Novara G, et al. Oncologic outcomes of robot-assisted radical cystectomy: results of a high-volume robotic center. J Endourol Endourol Soc. 2016;30(1):75–82.CrossRefGoogle Scholar
  40. 40.
    Nguyen DP, Al Hussein Al Awamlh B, Wu X, O’Malley P, Inoyatov IM, Ayangbesan A, et al. Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer. Eur Urol. 2015;68(3):399–405.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Ost MC, Patel KP, Rastinehad AR, Chu PY, Anderson AE, Smith AD, et al. Pneumoperitoneum with carbon dioxide inhibits macrophage tumor necrosis factor-α secretion: source of transitional-cell carcinoma port-site metastasis, with prophylactic irrigation strategies to decrease laparoscopic oncologic risks. J Endourol. 2008;22(1):105–12.PubMedCrossRefGoogle Scholar
  42. 42.
    Torrey RR, Chan KG, Yip W, Josephson DY, Lau CS, Ruel NH, et al. Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal indiana pouch continent cutaneous urinary diversion. Urology. 2012;79(5):1073–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Tyritzis SI, Hosseini A, Collins J, Nyberg T, Jonsson MN, Laurin O, et al. Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol. 2013;64(5):734–41.PubMedCrossRefGoogle Scholar
  44. 44.
    Canda AE, Atmaca AF, Altinova S, Akbulut Z, Balbay MD. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int. 2012;110(3):434–44.PubMedCrossRefGoogle Scholar
  45. 45.
    Messer JC, Punnen S, Fitzgerald J, Svatek R, Parekh DJ. Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int. 2014;114(6):896–902.PubMedCrossRefGoogle Scholar
  46. 46.
    Aboumohamed AA, Raza SJ, Al-Daghmin A, Tallman C, Creighton T, Crossley H, et al. Health-related quality of life outcomes after robot-assisted and open radical cystectomy using a validated bladder-specific instrument: a multi-institutional study. Urology. 2014;83(6):1300–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Smith A, Kurpad R, Lal A, Nielsen M, Wallen EM, Pruthi RS. Cost analysis of robotic versus open radical cystectomy for bladder cancer. J Urol. 2010;183(2):505–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology. 2011;77(3):621–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Smith AB, Raynor M, Amling CL, Busby JE, Castle E, Davis R, et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A. 2012;22(1):17–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Kurpad R, Woods M, Pruthi R. Current status of robot-assisted radical cystectomy and intracorporeal urinary diversion. Curr Urol Rep. 2016;17(6):42.PubMedCrossRefGoogle Scholar
  51. 51.
    Chan KG, Collins JW, Wiklund NP. Robot-assisted radical cystectomy: extracorporeal vs intracorporeal urinary diversion. J Urol. 2015;193(5):1467–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Pyun JH, Kim HK, Cho S, Kang SG, Cheon J, Lee JG, et al. Robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparative analysis with extracorporeal urinary diversion. J Laparoendosc Adv Surg Tech. 2016;26(5):349–55.CrossRefGoogle Scholar
  54. 54.
    Chan KG, Guru K, Wiklund P, Catto J, Yuh B, Novara G, et al. Robot-assisted radical cystectomy and urinary diversion: technical recommendations from the Pasadena Consensus Panel. Eur Urol. 2015;67(3):423–31.PubMedCrossRefGoogle Scholar
  55. 55.
    Smith ND, Castle EP, Gonzalgo ML, Svatek RS, Weizer AZ, Montgomery JS, et al. The RAZOR (randomized open vs robotic cystectomy) trial: study design and trial update. BJU Int. 2015;115(2):198–205.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Miami – Miller School of MedicineMiamiUSA
  2. 2.Department of UrologyUniversity of Miami – Miller School of MedicineMiamiUSA

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