title: Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts.
abstract: BACKGROUND
  Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. The majority of these series have reported techniques and outcomes in a predominantly male patient population. The application of such novel techniques to female cystectomy and anterior exenterative procedures has not been well documented and described. In this paper, we report our initial experience with robotic anterior pelvic exenteration in the female with bladder cancer evaluating perioperative and pathologic outcomes of this novel procedure and comparing the outcomes to those observed in their male counterparts.
  
  
  METHODS
  Fifty patients underwent a robotic radical cystectomy and extracorporeal diversion for clinically localized bladder cancer: 40 male patients (robotic radical cystoprostatetctomy) and 10 women (robotic anterior pelvic exenteration). Outcome measures evaluated in this series included operative variables, hospital recovery, pathologic outcomes, and complication rate.
  
  
  RESULTS
  Mean age of female patients was 68.4 years and of male patients was 62.8. Mean operating room time was 4.6 hours, and mean surgical blood loss was 215 mL. On surgical pathology, 5 patients were <=pT2, 3 patients pT3, and 2 patients N+. In no case was there a positive surgical margin, though in 1 case there was inadvertent entry into the bladder. Mean number of lymph nodes removed was 19 (range, 12-34). Mean time to flatus was 1.9 days, time to bowel movement 2.4 days, and time to discharge 4.9 days. These outcomes were comparable to the male patients, particularly the 20 male patients undergoing robotic radical cystoprostatectomy during the same time period.
  
  
  CONCLUSIONS
  In our experience, the robotic anterior exenteration has been readily adapted to the surgical treatment of bladder cancer with similar outcomes to those observed in male patients undergoing a robotic radical cystoprostatectomy. The approach appears to achieve the clinical and oncologic goals of radical cystectomy in both the female and male patient.
authors.affiliation: Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. rpruthi@med.unc.edu
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.forename: Heather
authors.initials: H
authors.lastname: Stefaniak
authors.forename: J Slade
authors.initials: JS
authors.lastname: Hubbard
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000379:methods*; D011468:Prostatectomy; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*