Robotic Cystectomy

  • Michael WoodsEmail author
  • Raj S. Pruthi
  • Erik P. Castle


Muscle invasive bladder cancer is a lethal disease requiring aggressive treatment. The current standard of care for treatment is a radical cystectomy and urinary diversion. This procedure is curative for the majority of patients but the subsequent morbidity is well established. It was this high complication rate and prolonged patient convalescence that motivated urologic surgeons to develop minimally invasive techniques for radical cystectomy. This led to the first report of robot-assisted radical cystectomy a decade ago. Over the past 10 years, there has been increasing utilization of this procedure with dissemination into mainstream urologic practice. The goal of this chapter is provide a detailed description of a robot-assisted radical cystectomy and provide some technical insights from the authors’ cumulative experience to improve efficiency and avoid pitfalls. In addition, a brief review of some of the available data on this topic will be discussed.


Radical cystectomy Urothelial carcinoma Robotic surgery Minimally invasive surgery Complications Extracorporeal urinary diversion 


  1. 1.
    Lowrance WT, Rumohr JA, Chang SS, Clark PE, Smith Jr JA, Cookson MS. Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol. 2008;179:1313–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Parra RO, Andrus CH, Jones JP. Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol. 1992;148:1140–4.PubMedGoogle Scholar
  3. 3.
    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;92:232–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Guru KA, Kim HL, Piacente PM, Mohler JL. Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute. Urology. 2007;69:469–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Lowentritt BH, Castle EP, Woods M, Davis R, Thomas R. Robot-assisted radical cystectomy in women: technique and initial experience. J Endourol. 2008;22:709–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robot-assisted laparoscopic anterior pelvic exenteration for bladder cancer in the female patient. J Endourol. 2008;22:2397–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Woods M, Thomas R, Davis R, Andrews PE, Ferrigni RG, Cheng J, et al. Robot-assisted extended pelvic lymphadenectomy. J Endourol. 2008;22:1297–302.PubMedCrossRefGoogle Scholar
  8. 8.
    Kauffman EC, Ng CK, Lee MM, Otto BJ, Portnoff A, Wang GJ, et al. Critical analysis of complications after robotic-assisted radical cystectomy with identification of preoperative and operative risk factors. BJU Int. 2010;105:520–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Treiyer A, Saar M, Kopper B, Kamradt J, Siemer S, Stockle M. Robotic-assisted laparoscopic radical cystectomy: evaluation of functional and oncological results. Actas Urol Esp. 2011;35:152–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Khan MS, Elhage O, Challacombe B, Rimington P, Murphy D, Dasgupta P. Analysis of early complications of robotic-assisted radical cystectomy using a standardized reporting system. Urology. 2011;77:357–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Hayn MH, Hellenthal NJ, Hussain A, Stegemann AP, Guru KA. Defining morbidity of robot-assisted radical cystectomy using a standardized reporting methodology. Eur Urol. 2011;59:213–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Kang SG, Kang SH, Lee YG, Rha KH, Jeong BC, Ko HM, et al. Robot-assisted radical cystectomy and pelvic lymph node dissection: a multi-institutional study from Korea. J Endourol. 2010;24:1435–40.PubMedCrossRefGoogle Scholar
  13. 13.
    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;22:17–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Ng CK, Kauffman EC, Lee MM, Otto BJ, Portnoff A, Ehrlich JR, et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol. 2010;57:274–81.PubMedCrossRefGoogle Scholar
  15. 15.
    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;57:196–201.PubMedCrossRefGoogle Scholar
  16. 16.
    Parekh DJ, Messer J, Fitzgerald J, Ercole M, Svatek R. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189:474–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Dotan ZA, Kavanagh K, Yossepowitch O, Kaag M, Olgac S, Donat M, et al. Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol. 2007;178: 2308–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Hadjizacharia P, Stein JP, Cai J, Miranda G. The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer. World J Urol. 2009;27:33–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Hellenthal NJ, Hussain A, Andrews PE, Carpentier P, Castle E, Dasgupta P, et al. Surgical margin status after robot assisted radical cystectomy: results from the international robotic cystectomy consortium. J Urol. 2010;184:87–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Schumacher MC, Jonsson MN, Wiklund NP. Robotic cystectomy. Scand J Surg. 2009;98:89–95.PubMedGoogle Scholar
  21. 21.
    Pruthi RS, Nielsen ME, Nix J, Smith A, Schultz H, Wallen EM. Robotic radical cystectomy for bladder cancer: surgical adn pathological outcomes in 100 consecutive cases. J Urol. 2010;183:510–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Novara G, Svatek RS, Karakiewicz PI, Skinner E, Ficarra V, Fradet Y, et al. Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol. 2010;183:2165–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Leissner J, Hohenfellner R, Thuroff JW, Wolf HK. Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder: significance for staging and prognosis. BJU Int. 2000;85:817–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Poulsen AL, Horn T, Steven K. Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. J Urol. 1998;160: 2015–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Herr H, Lee C, Chang S, Lerner S, Bladder Cancer Collaborative Group. Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol. 2004;171:1823–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere White R, Sarosdy MF, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. 2004;22:2781–9.PubMedCrossRefGoogle 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. 2010;107:642–6.CrossRefGoogle Scholar
  28. 28.
    Davis JW, Gaston K, Anderson R, Dinney CP, Grossman HB, Munsell MF, et al. Robot assisted extended pelvic lymphadenectomy at radical cystectomy: lymph node yield compared with second look open dissection. J Urol. 2010;185:79–84.PubMedCrossRefGoogle Scholar
  29. 29.
    Lavery HJ, Martinez-Suarez HJ, Abaza R. Robotic extended pelvic lymphadenectomy for bladder cancer with increased nodal yield. BJU Int. 2010;107:1802–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Pruthi RS, Wallen EM. Is robotic radical cystectomy an appropriate treatment for bladder cancer? Short-term oncologic and clinical follow-up in 50 consecutive patients. Urology. 2008;72:617–22.PubMedCrossRefGoogle Scholar
  31. 31.
    Dasgupta P, Rimington P, Murphy D, Challacombe B, Hemal A, Elhage O, et al. Robotic assisted radical cystectomy: short to medium term oncologic and functional outcomes. Int J Clin Pract. 2008;62:1709–14.PubMedCrossRefGoogle Scholar
  32. 32.
    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;105:1706–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Kauffman EC, Ng CK, Lee MM, Otto BJ, Wang GJ, Scherr DS. Early oncologic outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int. 2010;107:628–35.PubMedCrossRefGoogle Scholar
  34. 34.
    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. 2013;31:1621.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Michael Woods
    • 1
    Email author
  • Raj S. Pruthi
    • 2
    • 3
  • Erik P. Castle
    • 4
  1. 1.Department of UrologyThe University of North Carolina Chapel HillChapel HillUSA
  2. 2.Department of UrologyChapel HillUSA
  3. 3.UNC School of Medicine at Chapel HillChapel HillUSA
  4. 4.Department of UrologyMayo Clinic ArizonaPhoenixUSA

Personalised recommendations