REVIEW   Free access

Minerva Urologica e Nefrologica 2019 August;71(4):301-8

DOI: 10.23736/S0393-2249.19.03435-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Current role of robotic bladder cancer surgery

Stavros I. TYRITZIS ^{1, 2} ✉, Josep M. GAYA ³, Anna WALLESTEDT-LANTZ ¹, Giovannalberto PINI ⁴, Wouter EVERAERTS ^{5, 6}, Geert de NAEYER ⁷, Joan PALOU ³, John KELLY ^{8, 9}, Nils P. WIKLUND ^{1, 10}

¹ Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden; ² Department of Urology, HYGEIA Hospital, Athens, Greece; ³ Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain; ⁴ Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy; ⁵ Department of Urology, KU Leuven, Leuven, Belgium; ⁶ Department of Development and Regeneration, KU Leuven, Leuven, Belgium; ⁷ Department of Urology, OLV, Aalst, Belgium; ⁸ Division of Surgery and Interventional Science, University College London, London, UK; ⁹ Department of Urology, University College London Hospital, London, UK; ¹⁰ ICAHN School of Medicine, Mount Sinai Hospital, New York, NY, USA

INTRODUCTION: Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC.
EVIDENCE ACQUISITION: A non-systematic review on all relevant studies with the keywords “Radical cystectomy,” “Open,” “Robot-assisted,” “Complications,” “Recurrence,” “Survival,” “Neobladder,” “Potency,” “Continence” and “Intracorporeal” was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines.
EVIDENCE SYNTHESIS: RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique.
CONCLUSIONS: As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.

KEY WORDS: Cystectomy, complications; Robotics; Recurrence; Survival