The clinical spectrum of bladder cancer ranges from superficial to metastatic disease at presentation. The most important treatment-related issues include the identification of those who can be adequately managed without total cystectomy, those who need radical cystectomy, and those who require a combined modality approach that includes chemotherapy and/or radiation therapy (RT).
Radical cystectomy is the treatment of choice for high-risk superficial disease as well as localized but muscle-invasive bladder cancer. Traditionally, radical cystectomy has been performed using an open approach that allows wide excision of the bladder, extended lymph node dissection, and a full range of urinary diversion procedures.
The goal of minimally invasive radical cystectomy (with or without robotic assistance) is to reproduce the oncologic results of an open procedure, while decreasing the surgical complications and postoperative recovery time. Laparoscopy was first used for removal of the urinary bladder in 1992 , and subsequent advances have evolved towards a robotic-assisted intracorporeal approach to include extended lymph node dissection and totally intracorporeal urinary diversion.
The technical aspects of laparoscopic/robotic radical cystectomy and the early results with this approach are reviewed here. The role of open radical cystectomy is discussed separately. (See "Radical cystectomy and bladder-sparing treatments for urothelial (transitional cell) bladder cancer".)
The goal of minimally-invasive radical cystectomy (with or without robotic assistance) is to reproduce the oncologic results of an open procedure, while minimizing surgical complications and postoperative recovery time. The technique continues to evolve.