Surgery-related complications of robot-assisted radical cystectomy with intracorporeal urinary diversion.
OBJECTIVE
To assess the surgery-related complications at robot-assisted radical cystectomy with total intracorporeal urinary diversion during our learning curve in treating 45 patients with bladder cancer.


METHODS
A total of 45 patients were pooled in 3 consecutive groups of 15 cases each to evaluate the complications according to the Clavien classification. As a surrogate for our learning curve, the following parameters were assessed: operative time, blood loss, urinary diversion type, lymph node yield, surgical margin status, and length of hospital stay.


RESULTS
Early surgery-related complications were noted in 40% of the patients and late complications in 30%. The early Clavien grade III complications remained significant (27%) and did not decline with time. Overall, fewer complications were observed between the groups over time, with a significant decrease in late versus early complications (P = .005 and P = .058). The mean operative times declined from the first group to the second and third groups (P = .005) and the hospital stays shortened (P = .006). No significant difference was observed between groups regarding the lymph node yield at cystectomy (P = .108), with a mean of 22.5 nodes (range 10-52) removed. More patients received an orthotopic bladder substitute (Studer) in each of the latter 2 groups than in the first.


CONCLUSIONS
Although robot-assisted radical cystectomy with total intracorporeal urinary diversion is a complex procedure, we observed decreased surgery-related complications and improved outcomes over time in the present series. Our results need to be confirmed by others before robot-assisted radical cystectomy with totally intracorporeal urinary diversion can be accepted as a treatment option for patients with bladder cancer.
Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden. Martin.Schumacher@ki.se
Martin C
MC
Schumacher
Martin N
MN
Jonsson
Abolfazl
A
Hosseini
Tommy
T
Nyberg
Vassilis
V
Poulakis
Nikolaos P
NP
Pardalidis
Hubert
H
John
Peter N
PN
Wiklund
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*