Complications After Robotic Bladder Surgery

  • Stefan SiemerEmail author


Especially with bladder surgery, surgeons have to be aware of various potential complications. Their knowledge and skills to manage them are essentially important. Complications compromise patient outcomes and prolong operative time or length of hospital stay. Robotic surgery might have the potential to reduce complications, but bladder surgery is still technically demanding including the need of urinary diversion for radical cystectomy. Complications after robotic bladder surgery may occur at different types of surgery, mainly the radical cystectomy approach. With an increasing experience with robotic procedures such as radical cystectomy and due to the positive impact of minimal invasive techniques on morbidity, robotic technology in bladder surgery is applied to a wider variety of bladder procedures such as partial bladder resection, diverticulectomy and ureteral reimplantation. Some complications are associated with the laparoscopic technique and the robotic equipment such as port positioning, robotic surgical access and malfunctioning of instruments (Chap.  48). But there are other complications, attributable to the specific procedures and seen independently form the approach with open surgery, respectively. Therefore the most common complications on patients undergoing robot assisted bladder surgery will be mentioned and some suggestions for intraoperative solutions and their prevention will be provided.


  1. 1.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Chang SS, Cookson MS, Baumgartner RG, et al. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol. 2002;167:2012–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Quek ML, Stein JP, Daneshmand S, et al. A critical analysis of perioperative mortality from radical cystectomy. J Urol. 2006;175:886–9. discussion 889-890CrossRefPubMedGoogle Scholar
  5. 5.
    Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Stimson CJ, Chang SS, Barocas DA, et al. Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series. J Urol. 2010;184:1296–300.CrossRefPubMedGoogle Scholar
  7. 7.
    Anonymous. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.CrossRefGoogle Scholar
  8. 8.
    Parekh DJ, Messer J, Fitzgerald J, et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189:474–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Bochner BH, Sjoberg DD, Laudone VP. A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med. 2014;371:389–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Khan MS, Gan C, Ahmed K, et al. A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2016;69:613–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Shen Z, Sun Z. Systematic review and meta-analysis of randomised trials of perioperative outcomes comparing robot-assisted versus open radical cystectomy. BMC Urol. 2016;16:59.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ahmed K, Khan SA, Hayn MH, 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;65:340–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Ng CK, Kauffman EC, Lee MM, et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol. 2010;57:274–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Bak DJ, Lee YJ, Woo MJ, et al. Complications and oncologic outcomes following robot-assisted radical cystectomy: what is the real benefit? Investigative and clinical urology. 2016;57:260–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gandaglia G, Karl A, Novara G, et al. Perioperative and oncologic outcomes of robot-assisted vs. open radical cystectomy in bladder cancer patients: a comparison of two high-volume referral centers. Eur J Surg Oncol. 2016;42(11):1736–43.CrossRefPubMedGoogle Scholar
  16. 16.
    Tan WS, Khetrapal P, Tan WP, et al. Robotic assisted radical cystectomy with extracorporeal urinary diversion does not show a benefit over open radical cystectomy: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2016;11:e0166221.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hautmann RE, De Petriconi RC, Volkmer BG. Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol. 2010;184:990–4. quiz 1235CrossRefPubMedGoogle Scholar
  18. 18.
    Johar RS, Hayn MH, Stegemann AP, et al. Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2013;64:52–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Saar M, Ohlmann CH, Siemer S, et al. Fast-track rehabilitation after robot-assisted laparoscopic cystectomy accelerates postoperative recovery. BJU Int. 2013;112:E99–106.CrossRefPubMedGoogle Scholar
  20. 20.
    Porpiglia F, Tarabuzzi R, Cossu M, et al. Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery. Urology. 2002;60:1045–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Tufek I, Mourmouris P, Argun OB, et al. Robot-assisted bladder diverticulectomy with concurrent management of bladder outlet obstruction. Urol Int. 2016;96:432–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Davidiuk AJ, Meschia C, Young PR, et al. Robotic-assisted bladder diverticulectomy: assessment of outcomes and modifications of technique. Urology. 2015;85:1347–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Schiavina R, Zaramella S, Chessa F, et al. Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up. J Robot Surg. 2016;10:323–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Fifer GL, Raynor MC, Selph P, et al. Robotic ureteral reconstruction distal to the ureteropelvic junction: a large single institution clinical series with short-term follow up. J Endourol Soc. 2014;28:1424–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.University Clinics of SaarlandHomburgGermany

Personalised recommendations