Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

PURPOSE:Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min.) and mean blood loss was 294 mL (range: 50-2000 mL). In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classified as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1%). Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11% major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS:We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21 percent) had postoperative subclinical pelvic lymphoceles. Thirty patients (12 percent) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80 percent vs. 16 percent, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.