title: Robot-assisted laparoscopic radical cystectomy: initial experience on 27 consecutive patients.
abstract: Recent reports have demonstrated that robot-assisted laparoscopic cystectomy is technically feasible. We report technical and functional results of a large series of patients undergoing laparoscopic cystectomy with the da Vinci surgical system (DVSS). A total of 27 patients (24 males) underwent laparoscopic radical cystectomy with the DVSS (intuitive surgical) between January 2004 and December 2005. Indications for cystectomy were muscle-invasive transitional cell carcinoma (TCC) or leiomyosarcoma of the urinary bladder (n = 24) and bladder shrinking following prior radiotherapy for TCC. A pelvic lymphadenectomy was a routine part of the procedure. Urinary diversions were ilieal conduits (n = 19) and ileal neobladders (n = 8). Mean operating time was 340 min (range 150-450) with a mean blood loss of 301 ml (range 50-550). The mean number of lymph nodes retrieved during lymphadenectomy was 23. Surgical margins were negative except in one case. After a mean follow-up of 10.2 months, two perioperative (anastomotic leakage, adhesions) and three postoperative complications (ileus, intestinal fistula, urinary tract obstruction) occurred. Six out of seven patients reported satisfying erectile function following nerve-sparing surgery. Day-time continence was completely restored after a mean 3.5 months in seven of eight patients. Robot-assisted laparoscopic cystectomy is a safe procedure. Satisfying functional and oncological short-term results can be achieved within acceptable operating time limits.
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Carpentier
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Schatteman
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Fonteyne
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Hospital, Kirrbergerstrasse, 66421 Homburg/Saar, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Suttmann
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Hospital, Kirrbergerstrasse, 66421 Homburg/Saar, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stöckle
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Hospital, Kirrbergerstrasse, 66421 Homburg/Saar, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Siemer
keywords: Bladder cancer; Cystectomy; Da Vinci; Laparoscopy; Robot; Urinary diversion