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Robtic-assisted radical cystectomy: Literature review |
Marcio Covas Moschovasa,*(),Kulthe Ramesh Seetharam Bhata,Cathy Jensona,Vipul R. Patela,Gabriel Ogaya-Piniesb,c
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a Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States b Department of Urology, Hospital Rey Juan Carlos, Madrid, Spain c Lyx Instituto de Urologia, Madrid, Spain |
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Abstract Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard treatment for localized muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) with recurrence or high risk of progression. Also, the robotic approach to this type of surgery is well established in the literature. Our objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate cancer. We performed a literature review of articles describing the robotic approach to RC in patients with bladder cancer. Also, we described the procedure since the patient selection until the bladder removal. The reconstructive techniques were not included in this review. Twenty-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols, surgical technique, pathology report, oncological outcomes, complication rates, and quality of life after the procedure. Robotic-assisted radical cystectomy is feasible and safe with satisfactory oncological outcomes. The robotic approach is related to lower blood loss and fewer transfusion rates. However, when compared to open surgery, the use of this technology increases the operative time.
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Received: 20 December 2019
Available online: 20 January 2021
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Corresponding Authors:
Marcio Covas Moschovas
E-mail: marcio.doc@hotmail.com
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Trocar placement. Blue dots represent robotic ports. Red dots represent assistant ports.
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Intraoperative images. (A) Right ureter before clipping. Noticed the periureteral fat preservation. (B) Dissection of the left seminal vesicle (Green Arrow) and Denonvillier's fascia in the back (Blue Arrow). (C) Seminal Vesicles are pulled up while the free edge of the Denonvillier's fascia is pulled down in order to create the space to dissect the posterior plane of the prostate. (D) Right lateral dissection. The endopelvic fascia is open, and the lateral aspect of the prostate (blue arrow) is gently pulled apart from the elevator ani muscle (green arrow). (E) Once the lateral plane is connected to the posterior plane by dissecting the bladder and prostatic pedicles, the urachus is divided.
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