title: Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: initial experience.
abstract: BACKGROUND
  The use of robotic technology for laparoscopic prostatectomy is now well established. The same cannot yet be said of robotic-assisted laparoscopic radical cystectomy (RARC), which is performed in just a few centres worldwide.
  
  
  OBJECTIVE
  We present our technique and experience of this procedure using the da Vinci surgical system.
  
  
  METHODS
  From 2004 to 2007, 23 patients underwent RARC and urinary diversion at our institution.
  
  
  METHODS
  We report the development of our technique for RARC, which involves posterior dissection, lateral pedicle control, anterior dissection, and lymphadenectomy prior to either ileal conduit urinary diversion or Studer pouch reconstruction performed extracorporeally.
  
  
  METHODS
  Demographic and perioperative data were recorded prospectively. Oncologic and functional outcomes were assessed at 3- to 6-mo intervals.
  
  
  CONCLUSIONS
  To date, 23 patients have undergone this procedure at our institution. Of those, 19 had ileal loop urinary diversion and 4 were suitable for Studer pouch reconstruction. Mean total operative time plus or minus (+/-) standard deviation (SD) was 397+/-83.8min. Mean blood loss +/-SD was 278+/-229ml with one patient requiring a blood transfusion. Surgical margins were clear in all patients with a median +/-SD of 16+/-8.9 lymph nodes retrieved. The complication rate was 26%. At a mean follow-up +/-SD of 17+/-13 (range 4-40) mo, one patient had died of metastatic disease and one other is alive with metastases. The remaining 21 patients are alive without recurrence.
  
  
  CONCLUSIONS
  RARC remains a procedure in evolution in the small number of centres carrying out this type of surgery. Our initial experience confirms that it is feasible with acceptable morbidity and good short-term oncologic results.
authors.affiliation: Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. decmurphy@doctors.net.uk
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Challacombe
authors.forename: Oussama
authors.initials: O
authors.lastname: Elhage
authors.forename: Tim S
authors.initials: TS
authors.lastname: O'Brien
authors.forename: Peter
authors.initials: P
authors.lastname: Rimington
authors.forename: Mohammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion