Robotic Cystectomies Have Advantages

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They take longer than open surgery, but are associated with decreased blood loss and hospital stay.

 

Robotic radical cystectomy (RC) may offer advantages over open surgery without compromising pathologic measures of early oncologic efficacy, researchers suggest.

 

In a prospective study, Douglas S. Scherr, MD, and his collaborators at the New York-Presbyterian Hospital, Weill Medical College of Cornell University, compared 21 patients who underwent open RC and 33 who underwent RC using the da Vinci robotic system.

 

Compared with the open-surgery patients, those who underwent robotic RC had less blood loss (400 vs. 750 mL) and transfusion requirement (0.5 vs. 2.0 units), but longer operative time (390 vs. 300 minutes), according to a report in BJU International (2007; published online ahead of print).

 

Patients in the robotic RC group also had a decreased time to resumption of a regular diet (four vs. five days), and shorter hospital stay (5 vs. 8 days). The open and robotic RC groups had similar overall complication rates (24% and 21%, respectively).

 

The median number of lymph nodes removed was similar in the open and robotic groups (20 and 17, respectively). A higher proportion of patients in the open surgery group had positive surgical margins compared with the robotic cohort (14% vs. 6%), but the difference was not statistically significant. (A subsequent analysis showed that the positive surgical margin rate in the robotic group was actually 3%.)

 

“Overall, the present findings confirm the results of previous studies showing the potential benefits of robotic RC, including decreased blood loss, transfusion requirement, time to resumption of a regular diet, and hospital stay,” the authors wrote. “While operative duration is increased using the robotic technique, this does not appear to adversely affect recovery, and we have further shown that with increasing surgical volume, the operative duration for robotic RC can approach that of open RC.”

 

The team noted that the mean operative duration was decreased by 112 minutes in their most recent 16 robotic RC cases compared with their initial 16 cases. Dr. Scherr's group pointed out that a shortcoming of their study was it was a non-randomized comparison.

 

Many patients with a greater disease burden tended to undergo open surgery. Before RC, the open group had more patients with muscle-invasive disease than did the robotic cohort (71% vs. 49%) and had more patients with extravesical disease (57% vs. 28%) and nodal metastases (34% vs. 19%), the investigators reported.

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