title: Is robotic-assisted radical cystectomy (RARC) with intracorporeal diversion becoming the new gold standard of care?
abstract: BACKGROUND
  Totally intracorporeal robotic-assisted radical cystectomy (RARC) has perceived difficulties compared to open radical cystectomy (ORC). As the technique is increasingly adopted around the world, the benefits of RARC with intra- or extracorporeal urinary diversion or ORC for the patients are still unclear. In this article, we consider the current evidence for this issue.
  
  
  METHODS
  We assessed two questions through using expert opinion and the medical literature: (A) Is RARC better than ORC for removing the cancer surgery and outcome? (B) Is RARC better than ORC for the urinary diversion?
  
  
  RESULTS
  (A) RARC is better than ORC for shorter length of stay, blood loss and complication rates. (B) Intracorporeal orthotopic neobladder may have a significant physiological and surgical benefit to the patient recovery.
  
  
  CONCLUSIONS
  RARC with total intracorporeal reconstruction has potential benefits to the patient. We recommend that all surgeons document patient-related outcome measures, urodynamics and enhanced recovery protocols for cystectomy patients to help us understand the real improvements within bladder cancer surgery and reconstruction.
authors.affiliation: Department of Urology, University Hospital North Norway (UNN), Tromsö, Norway. hrhpatel@hotmail.com.
authors.forename: Hitendra R H
authors.initials: HR
authors.lastname: Patel
authors.affiliation: Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal.
authors.forename: Pedro Bargão
authors.initials: PB
authors.lastname: Santos
authors.affiliation: Department of Urology, Centro Hospitalar do Porto - Hospital de San Antonio, Oporto, Portugal.
authors.forename: Manuel Castanheira
authors.initials: MC
authors.lastname: de Oliveira
authors.affiliation: Department of Urology, Akershus University Hospital, Lørenskog, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Müller
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D065287:Robotic Surgical Procedures / Q000379:methods*; D059039:Standard of Care / Q000639:trends*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
keywords: Cystectomy; Intracorporeal urinary diversion; Peritoneal immunity; Robotics; Surgical ergonomics