Robot-assisted radical cystectomy: recent advances and review of the literature

Robot-assisted radical cystectomy (RARC) continues to provide a minimally invasive option to the management of bladder cancer. Its utilization appears to be steadily increasing. The purpose of this paper is to review recent advances and outcomes related to robot-assisted radical cystectomy.

There are an increasing number of publications and abstracts related to robot-assisted radical cystectomy. In a majority of these case series, the urinary diversion is performed extracorporeally due to improved operative times. There has been some larger series published within the last year, which have provided some meaningful insight into the perioperative and oncologic issues related to the procedure. Several of these reports have provided a retrospective comparison to open radical cystectomy. In experienced hands, this procedure can be accomplished in a reasonable amount of time with appropriate pathologic outcomes, whereas providing decreased complication rates, EBL, and transfusion rates as well as improved convalescence compared with open-radical cystectomy. Although no long-term survival data exists to date, intermediate-term follow-up is beginning to emerge and appears similar to open-radical cystectomy in nonrandomized comparisons.

Robot-assisted radical cystectomy is a reproducible, minimally invasive approach to radical cystectomy. Patients appear to derive benefit from this approach in regards to complications and convalescence without evidence of compromise to early and intermediate oncological outcomes. Long-term oncologic follow-up and, ideally, randomized prospective comparisons to open radical cystectomy are needed to further validate this procedure.