Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy.
OBJECTIVE
To prospectively compare perioperative and pathological outcomes in a consecutive series of patients undergoing radical cystectomy (RC) and urinary diversion by the open or the robotic approach.


METHODS
From February 2006 to April 2007, 54 consecutive patients underwent RC by one surgeon at our institution. Twenty-one were open, while 33 utilized the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). Data was collected prospectively, including patient demographics, operative and postoperative variables, and pathological outcomes.


RESULTS
The robotic cohort had decreased blood loss (400 vs 750 mL, P = 0.002) and transfusion requirement (2.0 vs 0.5 units, P = 0.007), but increased operative duration (390 vs 300 min, P = 0.03). The time to resumption of a regular diet (4 vs 5 days, P = 0.002) and the hospital stay (5 vs 8 days, P = 0.007) were decreased in the robotic group. Overall the complication rates were similar (24% open, 21% robotic, P = 0.3). The open cohort had more patients with extravesical disease (57 vs 28%, P = 0.03) and nodal metastasis (34 vs 19%, P = 0.04). There were three patients in the open group and two in the robotic with positive margins (P = 0.2). The median number of lymph nodes removed was similar in the open and robotic cohorts (20 vs 17, P = 0.6).


CONCLUSIONS
Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence.
Wang
Gerald J
GJ
Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
Barocas
Daniel A
DA
Raman
Jay D
JD
Scherr
Douglas S
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion