title: Controversies in Robotics: Open Versus Robotic Radical Cystectomy.
abstract: Open radical cystectomy (ORC) remains the gold standard for treatment of muscle-invasive bladder cancer and certain cases of high-risk noninvasive bladder cancer. However, ORC is associated with significant morbidity, and there is promise of improved outcomes with the emergence of minimally invasive surgery. Because of the increased adoption of robotic radical cystectomy (RRC), we sought to review the current literature on the robotic approach. We explored the surgical techniques, perioperative and postoperative complications, oncologic and functional outcomes, and quality of life of patients with RRC versus ORC. Current data appear to favor RRC in perioperative outcomes and patient recovery, although RRC continues to be associated with longer surgical times and higher costs. Oncologic data are also promising, however data on long-term oncologic outcomes are insufficient. To date, there is evidence of similar functional outcomes between RRC and ORC continence, but there is a paucity of rigorous, standardized studies on health-related quality of life for continent versus incontinent diversion. Even as use of RRC steadily grows, there is a lack of consensus on the type of approach and urinary diversion that is optimal. We assessed the influence of surgeon experience on the totally intracorporeal urinary diversion and its feasibility to be widely adopted. We aimed to answer the question of whether there are significant benefits to RRC, and furthermore, of the effect of the approach on the choice of urinary diversion.
authors.affiliation: Department of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: rutpatel@gmail.com.
authors.forename: Rutveej
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Julie
authors.initials: J
authors.lastname: Szymaniak
authors.affiliation: Department of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Kushan
authors.initials: K
authors.lastname: Radadia
authors.affiliation: Department of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Izak
authors.initials: I
authors.lastname: Faiena
authors.affiliation: Department of Urology, Jersey Shore University Medical Center, Neptune City, NJ.
authors.forename: Michael
authors.initials: M
authors.lastname: Lasser
mesh_terms: D015653:Cystectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Bladder cancer; Extracorporeal urinary diversion; Intracorporeal urinary diversion; Open radical cystectomy; Quality of life