[Robotic radical cystoprostatectomy: oncological and functional analysis].
BACKGROUND
The da Vinci robotic laparoscopic surgery, has been shown in radical prostatectomy, optimal functional and oncological results with a lower learning curve, greater comfort and vision for the surgeon, and proper preservation of the neurovascular bundles. This has led to begin the experience with robotic radical cystectomy (RRC).


OBJECTIVE
Review our initial experience in CRR, evaluating surgical and functional results obtained, and also immediate and short-term complications.


METHODS
Between December 2007 and January 2009 we performed nine robotic radical cystoprostatectomy and in seven patients robotic lymphadenectomy (LDN). Five patients had a muscle-invasive disease and 4 non-muscle invasive bladder cancer. The median age was 57 years (range 34-81). Urinary diversion was performed extracorporeally in all cases, 3 cases an ileal conduit and 6 an Studer neobladder in 3 of these 6 cases, the urethra-neobladder anastomosis was performed intracorporeally.


RESULTS
The average time of surgery was 300 minutes (range 280-420) in the ileal conduit and 360 (range 330-540) in the Studer. No cases required conversion or blood transfusion. The median number of nodes removed by LDN robotics was 10 (range 6-18). The pathology revealed 3 pT0. 2 CIS, 3 pT3, 1 pT4b (positive margins). With a median follow up of 7 months there have been no peritoneal implant and only one ureteral stenosis. Oral diet was initiated in 5 cases at 48 hours. Of the 6 patients with preserved sexual function preoperatively and followup of more than 3 months, 2 had full erection at 1 month, 2 at 3 and 6 months, and the remaining 2 presented with a full erection with 5 PD inhibitors at 3 and 9 months. All patients with neobladder presented correct daytime continence. The average hospital stay was 8.5 days (range 7-19).


CONCLUSIONS
The radical robotic cystectomy with extracorporeal reconstruction of the urinary diversion offers good early functional and surgical outcomes. The careful preservation of the neurovascular bundles in radical pelvic surgery provides excellent results in urinary and sexual function.
Palou Redorta
Joan
J
Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España. jpalou@fundacio-puigvert.es
Gaya Sopena
Josep María
JM
Gausa Gascón
Lluís
L
Sánchez-Martín
Francisco
F
Rosales Bordes
Antonio
A
Rodríguez Faba
Oscar
O
Villavicencio Mavrich
Humberto
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D001749:Urinary Bladder Neoplasms / Q000601:surgery*