RARC Pasadena Consensus Panel – Surgery in MotionEditorial by Monish Aron and Inderbir S. Gill on pp. 361–362 of this issueRobot-assisted Radical Cystectomy and Urinary Diversion: Technical Recommendations from the Pasadena Consensus Panel
Introduction
Robot-assisted radical cystectomy (RARC) was first described by Menon et al in 2003 [1]. Over the past 10 yr, RARC has pushed accepted standards of open radical cystectomy (ORC) and become the standard treatment for muscle-invasive bladder cancer. RARC has demonstrated operative, functional, and oncologic outcomes comparable to ORC.
The 2014 Pasadena Consensus Panel on RARC convened to review a decade of experience. In this paper, we summarize the surgical technical recommendations from the consensus group. We highlight aspects of the procedure that facilitate the transition from ORC to RARC and urinary diversion. We also discuss technical points to aid the advanced robotic surgeon. Finally, we emphasize key technical points that may affect oncologic, surgical, and functional outcomes.
Section snippets
Methods
The international Pasadena Consensus Panel consisted of a 2-d conference of experts in radical cystectomy and urinary reconstruction who reviewed the existing peer-reviewed literature on RARC, pelvic lymphadenectomy, and urinary reconstruction. This conference was organized in Pasadena, California, and convened at the City of Hope Cancer Center in Duarte, California. No commercial support was obtained for this conference. This report was compiled based on a comprehensive review of the most
Patient selection
The degree of difficulty of RARC varies based on patient-related and disease-specific features. Favorable characteristics include the following:
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Absence of previous abdominal surgery
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Favorable body mass index (BMI)
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No previous history of pelvic radiation
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No bulky disease
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No cardiovascular or pulmonary disease
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Good performance status
The selection process should include appropriate preoperative investigations to ensure fitness for surgery, especially the ability to tolerate prolonged pneumoperitoneum
Discussion
Over the past decade, surgical robotic technology has become increasingly accessible, and our overall robotic surgical experience has become more robust with refinements in technique and operative times. RARC has transitioned from the novel efforts of innovators and early adopters to what is now becoming the product of the early majority. Still early in our experience, the extracorporeal urinary diversion has made the transition from ORC to RARC palatable to many surgeons. RARC has become
Conclusions
Remarkable progress has been made in RARC, ePLND, and urinary diversion. The technique has been significantly refined since its inception and has been shown to be safe, reproducible, and oncologically sound. Increasing expertise and significant improvements in technology will help improve both operative and functional outcomes.
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Eliminating the routine use of postoperative drain placement in patients undergoing robotic-assisted radical cystectomy with intracorporeal urinary diversion
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Implementation of a nonopioid protocol following robot-assisted radical cystectomy with intracorporeal urinary diversion
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