Clinical analysis for undergoing robotic assisted radical cystectomy / 中华泌尿外科杂志

ABSTRACT

Objective To summarize the surgical experience and primary follow-up results for robotic assisted radical cystectomy ( RARC ) , as well as to evaluate the safety and feasibility of this procedure.Methods From Jan 2013 to Oct 2015, we retrospectively analysis the perioperative data and primary follow-up data from 35 patients who underwent radical cystectomy with Da VinCi robotic laparoscopic in urological institution of Changhai Hospital.The median age was 65 (ranging from 46 to 78) years.The amount of male cases were 34, the female case were 1.There were three kinds of urinary diversion, ureterocutaneostomy, Bricker operation and orthotopic neobladder, were 2, 26 and 7 respectively.We collected the parameters including operating time, estimated blood loss, blood transfusion volume, time to flatus,length of hospital stay,perioperative complication,time of recurrence,time of death and the reason of death.Results All of the related operations had been accomplished successfully, none of which had been converted to the open procedure.The estimated operating time of ureterostomy was (315.0 ±106.1) min, Ideal conduit was ( 443.2 ±93.2 ) min, Orthotopic bladder was ( 488.3 ±80.6 ) min.The estimated intraoperative blood loss was 260.0 ±108.6(100 to 500 )ml.5 cases of all patients were transfused 400ml red cell suspension, the transfusion rate was 14.2%.The mean time to flatus was 3.1 ±1.6(1 to 7) d.The estimated time to remove the gastric tube and the drainage tube was 4.2 ±2.2d(2-10d),10.8 ±5.1d(4-25d),respectively.The length of hospital stay after surgery was 12.4 ±5.17(6 to 25) d.Overall,17,8, 10,31 and 4 of these patients had disease, respectively.Perioperative complication mainly included intestinal obstruction and lymphatic fistula,which occured 4 cases and 5 cases,respectively, recovering.All of them recovered completely with appropriate treatment.Distant metastasis was noticed in 4 cases.3 of them died due to the metastasis.The mean follow-up for survivors was 16.6(4 to 46) months. the 1-year recurrence-free,cancer-specific and overall survival estimates were 95.7%, 95.7%and 89.5%, respectively.Conclusions According to the initial experience of surgery and surgical curative effect,RARC could be provided with advantages at minimally invasion, shorter length of hospital stay and lower ratio of complications,which is a safe and feasible procedure.