Laparoscopic/robotic-assisted radical cystectomy
- Monish Aron, MD, MCh, FRCS
Monish Aron, MD, MCh, FRCS
- Professor of Clinical Urology
- Co-Director, Robotic Surgery & Advanced Laparoscopy
- USC Institute of Urology, Keck School of Medicine
- University of Southern California
- Inderbir S Gill, MD, MCh
Inderbir S Gill, MD, MCh
- Chairman and Professor
- Department of Urology
- Executive Director of the USC Institute of Urology
- Associate Dean (Clinical Innovation)
- Keck School of Medicine
- University of Southern California
The clinical spectrum of bladder cancer ranges from non-muscle-invasive 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 may include chemotherapy and/or radiation therapy (RT).
Radical cystectomy is the treatment of choice for high-risk/recurrent non-muscle-invasive disease as well as organ-confined 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.
The goal of minimally invasive radical cystectomy (currently most often performed with robot 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 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
- Desai MM, Berger AK, Brandina RR, et al. Robotic and laparoscopic high extended pelvic lymph node dissection during radical cystectomy: technique and outcomes. Eur Urol 2012; 61:350.
- Leow JJ, Reese SW, Jiang W, et al. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol 2014; 66:569.
- Haber GP, Campbell SC, Colombo JR Jr, et al. Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches. Urology 2007; 70:910.
- Desai MM, Simone G, de Castro Abreu AL, et al. Robotic Intracorporeal Continent Cutaneous Diversion. J Urol 2017.
- Nix J, Smith A, Kurpad R, et al. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 2010; 57:196.
- Parekh DJ, Messer J, Fitzgerald J, et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol 2013; 189:474.
- Bochner BH, Sjoberg DD, Laudone VP, Memorial Sloan Kettering Cancer Center Bladder Cancer Surgical Trials Group. A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med 2014; 371:389.
- Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol 2015; 67:1042.
- Khan MS, Gan C, Ahmed K, et al. A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL). Eur Urol 2016; 69:613.
- Tang K, Xia D, Li H, et al. Robotic vs. open radical cystectomy in bladder cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2014; 40:1399.
- Ishii H, Rai BP, Stolzenburg JU, et al. Robotic or open radical cystectomy, which is safer? A systematic review and meta-analysis of comparative studies. J Endourol 2014; 28:1215.
- Mmeje CO, Martin AD, Nunez-Nateras R, et al. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy. Curr Urol Rep 2013; 14:26.
- Yu HY, Hevelone ND, Lipsitz SR, 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.
- Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology 2011; 77:621.
- Lee R, Ng CK, Shariat SF, et al. The economics of robotic cystectomy: cost comparison of open versus robotic cystectomy. BJU Int 2011; 108:1886.
- Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2014; 65:340.
- Simonato A, Gregori A, Lissiani A, et al. Laparoscopic radical cystoprostatectomy: our experience in a consecutive series of 10 patients with a 3 years follow-up. Eur Urol 2005; 47:785.
- Guillotreau J, Gamé X, Mouzin M, et al. Radical cystectomy for bladder cancer: morbidity of laparoscopic versus open surgery. J Urol 2009; 181:554.
- DeGer S, Peters R, Roigas J, et al. Laparoscopic radical cystectomy with continent urinary diversion (rectosigmoid pouch) performed completely intracorporeally: an intermediate functional and oncologic analysis. Urology 2004; 64:935.
- Tanaka K, Hara I, Takenaka A, et al. Incidence of local and port site recurrence of urologic cancer after laparoscopic surgery. Urology 2008; 71:728.
- Haber GP, Gill IS. Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years. BJU Int 2007; 100:137.
- Cathelineau X, Arroyo C, Rozet F, et al. Laparoscopic assisted radical cystectomy: the montsouris experience after 84 cases. Eur Urol 2005; 47:780.
- El-Tabey NA, Shoma AM. Port site metastases after robot-assisted laparoscopic radical cystectomy. Urology 2005; 66:1110.
- Pruthi RS, Nielsen ME, Nix J, et al. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol 2010; 183:510.
- Smith AB, Raynor M, Amling CL, et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A 2012; 22:17.
- Schumacher MC, Jonsson MN, Hosseini A, et al. Surgery-related complications of robot-assisted radical cystectomy with intracorporeal urinary diversion. Urology 2011; 77:871.
- 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.
- Ng CK, Kauffman EC, Lee MM, et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 2010; 57:274.
- Chade DC, Laudone VP, Bochner BH, Parra RO. Oncological outcomes after radical cystectomy for bladder cancer: open versus minimally invasive approaches. J Urol 2010; 183:862.
- Nepple KG, Strope SA, Grubb RL 3rd, Kibel AS. Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer. Urol Oncol 2013; 31:894.
- Martin AD, Nunez RN, Pacelli A, et al. Robot-assisted radical cystectomy: intermediate survival results at a mean follow-up of 25 months. BJU Int 2010; 105:1706.
- Kauffman EC, Ng CK, Lee MM, et al. Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int 2011; 107:628.
- Raza SJ, Wilson T, Peabody JO, et al. Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2015; 68:721.