Robot Assisted Radical Cystectomy

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Robot Assisted Radical Cystectomy Pelvic Lymph
Node Dissection Initial experience at Roswell
Park Cancer Institute
Khurshid A. Guru MD, Director, Robotic Surgery
Roswell Park Cancer Institute, Buffalo, NY,
USA. University at Buffalo, Buffalo, NY, USA,
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Experience at Roswell Park
250
Open
MIS
200
150
Number
100
50
0
FY 02
FY 03
FY 04
FY 05
FY 06
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Surgical TechniqueVideo
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Methods

• From November 2005 to June 2006, 20 consecutive
  patients underwent RARC, RAAE and Robot assisted
  PLND for advanced bladder cancer.
• 13 Men 7 Females
• Data was collected prospectively on patient
  demographics, intraoperative performance,
  oncological status and immediate postoperative
  outcome.

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Potential complicating factor
6
Results(Intraoperative Parameters)

• Average operative time
• Incision to specimen retrieval 197 minutes
• Pelvic lymph node dissection 44 minutes
• Urinary diversion 133 minutes
• Estimated blood loss - 555 ml
• Urinary diversion
• Ileal conduit 18 Open neobladder 2
• (neobladder urethral anastomosis performed with
  robotic assistance).

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Results

• No intraoperative complications
• One aborted due to extensive metastasis
• One open conversion. (Anesthetic pulmonary risk)
• Immediate postoperative complications
• 1 Pyelonephritis
• 1 SBO, LOA, SB Resection
• 1 SBO, Septic Shock, Death

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Pathology
1 Squamous Cell Carcinoma
1 Mucinous
Adenocarcinoma
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Number of Lymph Nodes
Mean 13 (6-26)
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Quality of Life
11
Conclusion

• Robot Assisted Radical Cystectomy with Pelvic
  Lymph node dissection can be safely performed in
  patients who are candidates for open cystectomy
• Long term oncological results and QOL outcomes
  will define its position in minimally invasive
  urologic oncology