title: Pelvic lymph node dissection and outcome of robot-assisted radical cystectomy for bladder carcinoma.
abstract: BACKGROUND
  Pelvic lymph node dissection (PLND) at the time of radical cystectomy for urothelial carcinoma of the bladder is critical for accurate staging and may improve oncologic outcomes. Minimally invasive approaches have been criticized for limiting the extent of the PLND. We reviewed our experience with PLND and its perioperative outcomes with robot-assisted laparoscopic radical cystectomy (RARC).
  
  
  METHODS
  Data were collected prospectively from 50 patients scheduled for RARC. Included in the analysis were patients who had RARC and a standard PLND. The entire extirpative portion of the procedure was performed using the da Vinci Robot (Intuitive Surgical, Sunnyvale, CA, USA).
  
  
  RESULTS
  A total of 41 patients were included in the study: 30 men and 11 women with a mean age of 69.7 years (range 49-85) and a mean body mass index of 26.9 (range 19.5-43.7). The median total operative time was 497.77 min (320-805). The mean estimated blood loss was 253.66 ml (range 50-700). The transfusion rate was 44% (18 out of 41) ranging from 0 to 4 units (median 0 units of blood). The mean total number of lymph nodes retrieved was 25.07 (range 4-68). Nodal metastases were seen in 14.63% (6/41). Rate of positive surgical margin was 4.87% (2/41). The median length of hospital stay was 8 days (5-37). The median duration of nasogastric tube, time to ambulation, first clear liquid intake, passage of colonic gas, time to bowel movement, and start of solid food intake were 1 (0-5), 2 (1-7), 3 (2-10), 4 (1-6), 5 (2-11) and 6 days (3-24), respectively.
  
  
  CONCLUSIONS
  An adequate PLND, comparable with that recommended for open surgery, can be performed safely with robot assistance. The perioperative outcomes were likewise comparable with that of the gold standard, open cystectomy.
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA.
authors.forename: Aldrin J
authors.initials: AJ
authors.lastname: Gamboa
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Young
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA.
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA.
authors.forename: Jose Benito
authors.initials: JB
authors.lastname: Abraham
authors.affiliation: Ohio State University, 540 Doan Hall, 410 W. 10th Ave Columbus, Columbus, OH 43210 USA.
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.affiliation: Vanguard Urologic Institute, 6400 Fannin St., Suite 2300, Houston, TX 77030 USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Ornstein
keywords: Cystectomy; Laparoscopic; Lymphadenectomy; Minimally invasive; Robotic