Ewha Med J.  2014 Mar;37(1):10-15. 10.12771/emj.2014.37.1.10.

Robot-Assisted Laparoscopic Radical Cystectomy

• Kim KH
• Lee DH

• KMID: 2171268
• DOI: http://doi.org/10.12771/emj.2014.37.1.10

Abstract

Robot-assisted laparoscopic radical cystectomy (RARC) for the treatment of muscle invasive bladder cancer is being increasingly applied. Radical cystectomy is complex procedure which should be performed with extensive lymph node dissection and urinary diversion. Currently, the techniques of RARC are well-described, and the feasibility and safety of RARC has been demonstrated. While extracorporeal approach is preferred method for urinary diversion, intracorporeal urinary diversion is gaining popularity. Positive surgical margins are similar to large open series but inferior for locally advanced disease. However, local recurrence and survival rates seem equivalent to open series at short and mid-term follow up. Randomized controlled trial should be conducted to rigorously assess the oncologic outcomes of RARC compared to open radical cystectomy.

Keyword

Urinary bladder neoplasms; Cystectomy; Robotics; Surgical procedures, minimal invasive

MeSH Terms

Cystectomy*
Follow-Up Studies
Lymph Node Excision
Recurrence
Robotics
Survival Rate
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1 Port placement. Six port placement is used for robot assisted laparoscopic radical cystectomy.

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  Fig. 2 Mobilization of ureter. Left ureter is mobilized up to ureterovesical junction preserving periureteral vascularity. U, ureter; B, urinary bladder.

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  Fig. 3 Posterior dissection. The plane between posterior aspect of prostate and rectum is developed following peritoneotomy of Douglas pouch. P, prostate; R, rectum.

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  Fig. 4 Lateral dissection. Right superior vesical artery is ligated using hemoclip.

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  Fig. 5 Anterior dissection. The bladder is mobilized off the anterior abdominal wall and pubic bone by an incision of anterior peritoneum including the urachus. P, pubic bone; B, urinary bladder.

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  Fig. 6 Pelvic lymph node dissection. Left lymph node dissection is performed. E, external iliac artery; I, internal iliac artery; O, obturator nerve.

Reference

1. Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2013; 63:45–57.

2. Stenzl A, Cowan NC, De Santis M, Kuczyk MA, Merseburger AS, Ribal MJ, et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol. 2011; 59:1009–1018.

3. Stein JP, Skinner DG. Radical cystectomy for invasive bladder cancer: long-term results of a standard procedure. World J Urol. 2006; 24:296–304.

4. Hautmann RE, de Petriconi RC, Volkmer BG. Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol. 2010; 184:990–994.

5. Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011; 185:2207–2212.

6. Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol. 2013; 63:67–80.

7. Merseburger AS, Herrmann TR, Shariat SF, Kyriazis I, Nagele U, Traxer O, et al. EAU guidelines on robotic and single-site surgery in urology. Eur Urol. 2013; 64:277–291.

8. Parra RO, Andrus CH, Jones JP, Boullier JA. Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol. 1992; 148:1140–1144.

9. 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; 56:26–29.

10. 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; 168:13–18.

11. Cathelineau X, Arroyo C, Rozet F, Barret E, Vallancien G. Laparoscopic assisted radical cystectomy: the montsouris experience after 84 cases. Eur Urol. 2005; 47:780–784.

12. Hemal AK, Kolla SB, Wadhwa P, Dogra PN, Gupta NP. Laparoscopic radical cystectomy and extracorporeal urinary diversion: a single center experience of 48 cases with three years of follow-up. Urology. 2008; 71:41–46.

13. Huang J, Lin T, Liu H, Xu K, Zhang C, Jiang C, et al. Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer: oncologic results of 171 cases with a median 3-year follow-up. Eur Urol. 2010; 58:442–449.

14. 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; 92:232–236.

15. Beecken WD, 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; 44:337–339.

16. Pruthi RS, Nielsen ME, Nix J, Smith A, Schultz H, Wallen EM. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol. 2010; 183:510–514.

17. 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; 77:357–362.

18. 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; 79:1073–1078.

19. Styn NR, Montgomery JS, Wood DP, Hafez KS, Lee CT, Tallman C, et al. Matched comparison of robotic-assisted and open radical cystectomy. Urology. 2012; 79:1303–1308.

20. Yu HY, 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; 61:1239–1244.

21. Wang GJ, Barocas DA, Raman JD, Scherr DS. Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy. BJU Int. 2008; 101:89–93.

22. Jeong W, Araki M, Park SY, Lee YH, Kumon H, Hong SJ, et al. Robot-assisted laparoscopic radical prostatectomy in the Asian population: modified port configuration and ultradissection. Int J Urol. 2010; 17:297–300.

23. Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950; 30:1511–1521.

24. Studer UE, Varol C, Danuser H. Orthotopic ileal neobladder. BJU Int. 2004; 93:183–193.

25. Challacombe BJ, Bochner BH, Dasgupta P, Gill I, Guru K, Herr H, et al. The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol. 2011; 60:767–775.

26. 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; 178:2308–2312.

27. 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.

28. 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; 62:1709–1714.

29. 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; 107:628–635.

30. 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; 65:193–200.

31. Dalbagni G, Genega E, Hashibe M, Zhang ZF, Russo P, Herr H, et al. Cystectomy for bladder cancer: a contemporary series. J Urol. 2001; 165:1111–1116.