Robot-assisted radical cystectomy with intracorporeal urinary diversion: impact on an established enhanced recovery protocol.
OBJECTIVE
To assess the impact of the introduction of robot-assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS).


METHODS
Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was perioperative outcomes including transfusion rate, complication rates, 30- and 90-day mortality rates, and LOS.


RESULTS
The demographics of the comparative groups showed no significant difference in age, gender distribution, and American Society of Anesthesiologists grade. A significant reduction in transfusion rate was seen in RARC vs ORC (P < 0.001). The median LOS for the RARC group was 8 vs 13 days for the ORC group (P < 0.001). There was trend to a lower total complication rate (48% vs 31%). The 30- and 90-day mortality rates were equivalent between the groups (2%).


CONCLUSIONS
Introduction of RARC and intracorporeal reconstruction represents the single biggest impact on our ERP, with significant reduction in transfusion rates and LOS, and a trend towards a lower complication rate.
Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Anthony
A
Koupparis
Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Christian
C
Villeda-Sandoval
Department of Anaesthetics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Nicola
N
Weale
Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Motaz
M
El-Mahdy
Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
David
D
Gillatt
Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Edward
E
Rowe
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
bladder cancer; enhanced recovery; robot-assisted radical cystectomy