Role of robot-assisted surgery for bladder cancer.
OBJECTIVE
To review the developments and current status of robot-assisted radical cystectomy (RARC) with pelvic lymphadenectomy (PLND) and urinary diversion for the treatment of bladder cancer.


RESULTS
RARC is growing steadily in 2008, and it is superseding pure laparoscopic radical cystectomy (LRC) at centers, where robot is available and increasingly becoming an option at major tertiary referral centers. RARC with PLND can be performed with tolerance and effectiveness. Urinary diversions with RARC are performed extracorporeally via a small incision as intracorporeal diversion takes a long operative time with associated morbidity and complications. Short-term oncologic follow-up data is satisfactory. Advantages of RARC are minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder with PLND, though depends on the experience and skills of the surgeon.


CONCLUSIONS
The future of RARC with extracorporeal reconstruction of urinary diversion (ECUD) looks optimistic as favored by the patients and surgeons alike and emerging as an alternate technique. Lack of uniform PLND, devoid of long-term oncological and functional outcome data are still issues to be answered.
Hemal
Ashok K
AK
Department of Urology, and Institute of Regenerative Medicine, Baptist Medical Center, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1094, USA. ahemal@wfubmc.edu
D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion