Robot-Assisted Laparoscopic Cystoprostatectomy with Extended Pelvic Lymphadenectomy,Extracorporeal Enterocystoplasty,and Intracorporeal Enterourethral Anastomosis: Initial Montsouris Experience *

Abstract

Background and Purpose:

Radical cystectomy is the gold standard for management of invasive and recurrent high-grade superficial bladder cancer. We present our initial experience with robot-assisted laparoscopic cystoprostatectomy (RALCP) with extended pelvic lymphadenectomy (epLAD) and intracorporeal enterourethral anastomosis (IEUA). A video demonstrating our technique is available online at www.liebertonline.com/end.

Patients and Methods:

Between April 2008 and March 2009, nine patients underwent RALCP with epLAD and IEUA at our institution. Operative technique, as described in detail (with video), was assessed for feasibility. A video demonstrating this technique is available online at www.liebertonline.com/end. Preoperative patient characteristics, operative data, as well as perioperative and pathologic outcomes were analyzed. All data were collected prospectively.

Results:

Median total operative time was 270 minutes (range 210–330): 60 minutes, bilateral epLAD; 90 minutes, RALCP; 60 minutes, open enterocystoplasty; 60 minutes (range 45–90), IEUA. Median blood loss was 400 mL (range 200–900 mL). All surgical margins were negative. Median number of lymph nodes removed was 11 (range 4–21). Postoperative complications were noted in three patients and included urinoma (n = 1), pyelonephritis (n = 1), and hematoma (n = 1).

Conclusion:

RALCP is feasible and can be performed safely and effectively with acceptable operative, pathologic, and short-term clinical outcomes. More experience with longer follow-up is necessary to further assess clinical and oncologic outcomes of robotic assisted laparoscopic cystectomy for treatment of bladder cancer.