Robotic radical cystectomy

Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in Urology. Several retrospective and prospective studies have demonstrated that robotic-assisted RC (RARC) represents a minimally invasive alternative to open surgery, showing non-inferiority in mid-term oncological outcomes. Moreover, important advantages related with  perioperative complications have also been published. The aim of this article is to describe RARC surgical steps and to review the most relevant ndings in the eld of RARC, focusing on its strengths and weaknesses when compared with open RC.

We performed a detailed step-by-step description of the RARC surgical technique, paying particular attention to its specific surgical details and adding our tips and tricks for an out standing performance. We also conducted a review of the most relevant articles in literature in terms of oncological, pathological and perioperative results. All these findings have been compared with the classical open radical cystectomy (ORC) technique.

None of the studies published have demonstrated RARC to have worse oncological outcomes (PSM,RFS, CSS, OS) compared to ORC. RARC shows a decrease in blood loss and transfusion rates. No differences have been observed in complications rate, length of hospital stay, quality of life, and time to bowel movement between both approaches. The two disadvantages of RARC compared to ORC are a longer operative time and increased cost. Operating time can be reduced with surgeons gaining experience and technique standardization. The cost disparities and operative time between ORC and RARC at high-volume academic centers are less pronounced than in the general medical community.

RARC is a technically feasible and safe approach, with oncological, pathological and perioperative results, at least, equivalent to ORC.