Robotic-assisted radical cystoprostatectomy

Open radical cystectomy (RC) with extended lymphadenectomy (EDL) is the surgical treatment of choice for organ-confined muscle-invasive bladder tumor and for high-risk superficial tumor unresponsive to BCG.

However, the development of laparoscopic techniques and their acceptance for the uro-oncological treatment of renal tumor and prostate cancer has made it possible to propose laparoscopic RC (LRC) as an alternative to open surgery in specialized centers. Since the first cases of Parra and Sánchez-Badajoz, all the published series coincide in highlighting the advantages of the laparoscopic approach over open surgery in terms of reduced bleeding, rapid recovery and fewer days of hospitalization, with comparable functional and oncologic results.

The appearance on the market of the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA) led Menon to publish the first robotic RC in 2003. As with radical prostatectomy, the robotic technique has demonstrated at least the same functional and oncologic results as the laparoscopic approach, with a shorter learning curve and greater comfort and vision for the surgeon.

The expansion of this new technology, especially outside our country, has led to several publications reporting the good initial results of robotic RC. In many of these centers, conventional laparoscopy has been replaced by robotic laparoscopy in cases of CR with LDN.

The aim of this article is to present our initial experience with robotic RC (da Vinci), evaluating the surgical and functional results (voiding continence and sexual potency), as well as the technical aspects of this new surgical modality and the immediate and short-term complications.