title: Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel.
abstract: BACKGROUND
  Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes.
  
  
  OBJECTIVE
  A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference.
  
  
  METHODS
  A systematic review of the literature was performed in agreement with the PRISMA statement.
  
  
  RESULTS
  Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques.
  
  
  CONCLUSIONS
  RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference.
  
  
  RESULTS
  Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.
authors.affiliation: City of Hope Cancer Center, Duarte, CA, USA. Electronic address: twilson@coh.org.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Wilson
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Khurshid
authors.initials: K
authors.lastname: Guru
authors.affiliation: New England Research Institutes, Inc., Watertown, MA, USA.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.affiliation: Urology STHLM, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Annerstedt
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
authors.affiliation: City of Hope Cancer Center, Duarte, CA, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Chan
authors.affiliation: University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: O.L.V. Clinic, Aalst, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou Redorta
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: University of Bern, Bern, Switzerland.
authors.forename: George
authors.initials: G
authors.lastname: Thalmann
authors.affiliation: Eberhard Karls University of Tübingen, Tubingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: City of Hope Cancer Center, Duarte, CA, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: James
authors.initials: J
authors.lastname: Catto
mesh_terms: D019985:Benchmarking; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D032921:Consensus; D015653:Cystectomy / Q000009:adverse effects / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000592:standards*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Cystectomy; Evidence-based review; Extracorporeal urinary reconstruction; Intracorporeal urinary reconstruction; RARC; Radical cystectomy; Robot-assisted radical cystectomy; Robotics; Urinary reconstruction