BERKELEY, CA (UroToday.com) - Anatomic robot-assisted radical cystectomy (ARRC) is emerging as a treatment alternative to open radical cystectomy for the treatment of invasive bladder cancer. Pathologic data is emerging, however, and at the present time intermediate-term oncologic efficacy is comparable, whereas long-term oncologic efficacy of ARRC remains largely unknown. Robot-assisted lymphadenectomy can achieve similar lymph node yields to those of open lymphadenectomy after radical cystectomy. High-volume surgeons and busy centers are more likely to perform an extended lymphadenectomy, reflecting a correlation between increasing surgeon and team comfort with advanced vascular dissection. ARRC can also achieve comparable positive margin rates to open radical cystectomy. Early survival outcomes are similar to those reported in contemporary open series.
In this article on ARRC, we have constructed a step-by-step manual for the successful performance of this complex operation, for a variety of indications. Whether the reader is a novice or experienced robotic surgeon, this manual can help one initiate or refine his technique. This manuscript highlights the indications, contra-indications, pre-operative work-up, and pre-operative set-up for a successful operation. A detailed all-inclusive list of required disposable, required non-disposable, and optional equipment is included. Furthermore, 16 high-quality intra-operative photographs outline the set-up, pertinent anatomy, and landmarks accompany the step-by-step description of ARRC in men and women, young and elderly, and early or advanced disease states. We also discuss the indications and rationale for salvage ARRC, palliative ARRC, prostate-sparing cystectomy, and vaginal- and/or uterus-sparing ARRC. A detailed description of the robot-assisted extended pelvic lymph node dissection, as well as intracorporeal urinary diversion, were beyond the scope of this manuscript. These topics are discussed in separate papers and videos in the same edition of Journal of Endourology and are must-reads as well.
The reader should also investigate the 20-minute video, located in Journal of Endourology and Part B, Videourology and produced by the authors, demonstrating ARRC to help augment one’s learning. Finally, the manual describes potential intra-operative pitfalls with detailed management strategies as well as post-operative management of complications. While ARRC can be a challenging operation, attention to anatomical and surgical detail as outlined in this paper can lead to excellent outcomes for our patients.
Written by:
Kyle A. Richards, MD and Ashok K. Hemal, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Wake Forest University Baptist Medical Center
Department of Urology
Winston-Salem, NC USA
Anatomic robot-assisted radical cystectomy - Abstract
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