Impact of previous abdominal surgery on robot-assisted radical cystectomy.
OBJECTIVE
We analyzed the effect of previous abdominal surgery (PAS) on consecutive patients who underwent robot-assisted radical cystectomy (RARC).


METHODS
From 2005 to 2008, 73 patients at a single institution underwent RARC with bilateral extended pelvic lymph node dissection and urinary diversion. Lysis of adhesions was performed robotically and laparoscopically. Records were reviewed to assess the impact of PAS on operative outcomes and complications up to 3 months after surgery.


RESULTS
Of the 73 patients, 37 (51%) had undergone PAS. Of these 37, 6 (16%) had PAS above the umbilicus, and 31 (84%) had surgery either above and below or strictly below the umbilicus. Patients with PAS were significantly older than those without (P<0.01). No statistically significant difference was seen with respect to blood loss, transfusion requirement, operative time, lysis of adhesion time, length of ICU stay, overall hospital stay, or the need for reoperation between patients with PAS and those without PAS. The overall postoperative complication rate was higher in the group with PAS (P=0.04). Lymph node yield was higher in patients without PAS (P<0.01). Patients with PAS below the umbilicus had a significantly longer hospital stay than patients with surgery strictly above the umbilicus had (P=0.01). Whether individuals had previously undergone single or multiple surgeries had no significance.


CONCLUSIONS
Robot-assisted radical cystectomy in patients with a history of previous surgery may carry a higher risk for postoperative complications. However, previous operations do not appear to affect the likelihood of a safely completed robotic operation. Patients should be counseled about their risk of obstacles after surgery.
Department of Urology, State University of New York at Buffalo, USA.
Bertram E
BE
Yuh
Joseph
J
Ciccone
Rameela
R
Chandrasekhar
Zubair M
ZM
Butt
Gregory E
GE
Wilding
Hyung L
HL
Kim
James L
JL
Mohler
Khurshid A
KA
Guru
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome