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Open versus robotic radical cystectomy with intracorporeal Studer diversion.

Atmaca AF, Canda AE, Gok B, Akbulut Z, Altinova S, Balbay MD - JSLS (2015 Jan-Mar)

Bottom Line: The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017).No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Yildirim Beyazit University, Ankara, Turkey.

ABSTRACT

Background and objectives: To compare open versus totally intracorporeal robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion in bladder cancer patients.

Methods: A retrospective comparison of open (n = 42) versus totally intracorporeal (n = 32) robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion was performed concerning patient demographic data, operative and postoperative parameters, pathologic parameters, complications, and functional outcomes.

Results: Patient demographic data and the percentages of patients with pT2 disease or lower and pT3-pT4 disease were similar between groups (P > .05). Positive surgical margin rates were similar between the open (n = 1, 2.4%) and robotic (n = 2, 6.3%) groups (P > .05). Minor and major complication rates were similar between groups (P > .05). Mean estimated blood loss was significantly lower in the robotic group (412.5 ± 208.3 mL vs 1314.3 ± 987.1 mL, P < .001). Significantly higher percentages of patients were detected in the robotic group regarding bilateral neurovascular bundle-sparing surgery (93.7% vs 64.3%, P = .004) and bilateral extended pelvic lymph node dissection (100% vs 71.4%, P = .001). The mean lymph node yield was significantly higher in the robotic group (25.4 ± 9.7 vs 17.2 ± 13.5, P = .005). The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017). Better trends were detected in the robotic group concerning daytime continence with no pad use (84.6% vs 75%, P > .05) and severe daytime incontinence (8.3% vs 16.6%, P > .05). No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).

Conclusions: Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

No MeSH data available.


Related in: MedlinePlus

a, Healed surgical wounds 4 months postoperatively in a 72-year-old female patient who underwent robot-assisted radical cystectomy (RARC), anterior pelvic exenteration, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction. b, Healed surgical wounds 6 months postoperatively in a 65-year-old male patient who underwent RARC, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction.
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Figure 6: a, Healed surgical wounds 4 months postoperatively in a 72-year-old female patient who underwent robot-assisted radical cystectomy (RARC), anterior pelvic exenteration, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction. b, Healed surgical wounds 6 months postoperatively in a 65-year-old male patient who underwent RARC, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction.

Mentions: Figures 1–5 show trocar placement sites and the appearance of the bilaterally preserved NVBs in the pelvis after RARC, bilateral extended PLND, and completed robotic intracorporeal Studer pouch reconstruction. Figure 5 shows the immediate postoperative abdominal appearance of a patient who underwent RARC, bilateral extended PLND, and intracorporeal Studer pouch urinary reconstruction. Figures 6a and 6b show healed surgical wounds after RARC and intracorporeal Studer pouch urinary reconstruction in a 72-year-old female patient and a 65-year-old male patient, respectively.


Open versus robotic radical cystectomy with intracorporeal Studer diversion.

Atmaca AF, Canda AE, Gok B, Akbulut Z, Altinova S, Balbay MD - JSLS (2015 Jan-Mar)

a, Healed surgical wounds 4 months postoperatively in a 72-year-old female patient who underwent robot-assisted radical cystectomy (RARC), anterior pelvic exenteration, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction. b, Healed surgical wounds 6 months postoperatively in a 65-year-old male patient who underwent RARC, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376220&req=5

Figure 6: a, Healed surgical wounds 4 months postoperatively in a 72-year-old female patient who underwent robot-assisted radical cystectomy (RARC), anterior pelvic exenteration, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction. b, Healed surgical wounds 6 months postoperatively in a 65-year-old male patient who underwent RARC, bilateral extended pelvic lymph node dissection, and intracorporeal Studer pouch urinary reconstruction.
Mentions: Figures 1–5 show trocar placement sites and the appearance of the bilaterally preserved NVBs in the pelvis after RARC, bilateral extended PLND, and completed robotic intracorporeal Studer pouch reconstruction. Figure 5 shows the immediate postoperative abdominal appearance of a patient who underwent RARC, bilateral extended PLND, and intracorporeal Studer pouch urinary reconstruction. Figures 6a and 6b show healed surgical wounds after RARC and intracorporeal Studer pouch urinary reconstruction in a 72-year-old female patient and a 65-year-old male patient, respectively.

Bottom Line: The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017).No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Yildirim Beyazit University, Ankara, Turkey.

ABSTRACT

Background and objectives: To compare open versus totally intracorporeal robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion in bladder cancer patients.

Methods: A retrospective comparison of open (n = 42) versus totally intracorporeal (n = 32) robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion was performed concerning patient demographic data, operative and postoperative parameters, pathologic parameters, complications, and functional outcomes.

Results: Patient demographic data and the percentages of patients with pT2 disease or lower and pT3-pT4 disease were similar between groups (P > .05). Positive surgical margin rates were similar between the open (n = 1, 2.4%) and robotic (n = 2, 6.3%) groups (P > .05). Minor and major complication rates were similar between groups (P > .05). Mean estimated blood loss was significantly lower in the robotic group (412.5 ± 208.3 mL vs 1314.3 ± 987.1 mL, P < .001). Significantly higher percentages of patients were detected in the robotic group regarding bilateral neurovascular bundle-sparing surgery (93.7% vs 64.3%, P = .004) and bilateral extended pelvic lymph node dissection (100% vs 71.4%, P = .001). The mean lymph node yield was significantly higher in the robotic group (25.4 ± 9.7 vs 17.2 ± 13.5, P = .005). The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017). Better trends were detected in the robotic group concerning daytime continence with no pad use (84.6% vs 75%, P > .05) and severe daytime incontinence (8.3% vs 16.6%, P > .05). No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).

Conclusions: Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

No MeSH data available.


Related in: MedlinePlus