title: Open versus robotic radical cystectomy with intracorporeal Studer diversion.
abstract: OBJECTIVE
  To compare open versus totally intracorporeal robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion in bladder cancer patients.
  
  
  METHODS
  A retrospective comparison of open (n = 42) versus totally intracorporeal (n = 32) robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion was performed concerning patient demographic data, operative and postoperative parameters, pathologic parameters, complications, and functional outcomes.
  
  
  RESULTS
  Patient demographic data and the percentages of patients with pT2 disease or lower and pT3-pT4 disease were similar between groups (P > .05). Positive surgical margin rates were similar between the open (n = 1, 2.4%) and robotic (n = 2, 6.3%) groups (P > .05). Minor and major complication rates were similar between groups (P > .05). Mean estimated blood loss was significantly lower in the robotic group (412.5 ± 208.3 mL vs 1314.3 ± 987.1 mL, P < .001). Significantly higher percentages of patients were detected in the robotic group regarding bilateral neurovascular bundle-sparing surgery (93.7% vs 64.3%, P = .004) and bilateral extended pelvic lymph node dissection (100% vs 71.4%, P = .001). The mean lymph node yield was significantly higher in the robotic group (25.4 ± 9.7 vs 17.2 ± 13.5, P = .005). The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017). Better trends were detected in the robotic group concerning daytime continence with no pad use (84.6% vs 75%, P > .05) and severe daytime incontinence (8.3% vs 16.6%, P > .05). No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).
  
  
  CONCLUSIONS
  Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.
authors.affiliation: School of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
authors.affiliation: School of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
authors.affiliation: Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Bahri
authors.initials: B
authors.lastname: Gok
authors.affiliation: School of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Akbulut
authors.affiliation: Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Altinova
authors.affiliation: Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey.
authors.forename: Mevlana Derya
authors.initials: MD
authors.lastname: Balbay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion
keywords: Comparison; Intracorporeal; Open versus robotic; Robotic radical cystectomy; Studer pouch
references.citation: BJU Int. 2003 Apr;91(6):485-8
references.pmid: 12656899
references.citation: Urol Oncol. 2007 Jan-Feb;25(1):66-71
references.pmid: 17208142
references.citation: BJU Int. 2013 Aug;112(4):E290-4
references.pmid: 23815802
references.citation: J Urol. 2013 Feb;189(2):474-9
references.pmid: 23017529
references.citation: J Urol. 2004 May;171(5):1823-8; discussion 1827-8
references.pmid: 15076285
references.citation: J Urol. 2003 Jul;170(1):35-41
references.pmid: 12796639
references.citation: J Urol. 1996 Feb;155(2):490-4
references.pmid: 8558643
references.citation: Urology. 2011 Feb;77(2):357-62
references.pmid: 20828801
references.citation: World J Urol. 2007 Apr;25(2):193-8
references.pmid: 17171562
references.citation: BJU Int. 2008 Jan;101(1):89-93
references.pmid: 17888044
references.citation: J Endourol. 2011 Sep;25(9):1469-79
references.pmid: 21830910
references.citation: J Endourol. 2012 Jun;26(6):670-5
references.pmid: 22011001
references.citation: Eur Urol. 2010 Feb;57(2):196-201
references.pmid: 19853987
references.citation: Can Urol Assoc J. 2010 Oct;4(5):328-31
references.pmid: 20944805
references.citation: Urology. 2011 Apr;77(4):871-6
references.pmid: 21256563
references.citation: Curr Opin Urol. 2007 Sep;17(5):369-75
references.pmid: 17762633
references.citation: Urology. 1997 Jun;49(6):822-30
references.pmid: 9187685
references.citation: J Clin Oncol. 2004 Jul 15;22(14):2781-9
references.pmid: 15199091
references.citation: Eur Urol. 2010 Feb;57(2):274-81
references.pmid: 19560255
references.citation: BJU Int. 2000 May;85(7):817-23
references.pmid: 10792159
references.citation: Ann Surg. 2004 Aug;240(2):205-13
references.pmid: 15273542
references.citation: Eur Urol. 2008 Sep;54(3):570-80
references.pmid: 18423976
references.citation: J Urol. 2010 Jul;184(1):87-91
references.pmid: 20478596
references.citation: BJU Int. 2008 Jul;102(2):231-4; discussion 234
references.pmid: 18325058
references.citation: BJU Int. 2012 Aug;110(3):434-44
references.pmid: 22177416
references.citation: BJU Int. 2003 Aug;92(3):232-6
references.pmid: 12887473
references.citation: J Endourol. 2013 Jan;27(1):40-4
references.pmid: 22788707
references.citation: Urology. 2012 Jun;79(6):1303-8
references.pmid: 22516354
references.citation: J Urol. 2010 Feb;183(2):510-4
references.pmid: 20006884