Robot-assisted radical cystectomy: Review of surgical technique, and perioperative, oncological and functional outcomes.

Since the introduction of robot-assisted radical cystectomy, efforts have been made to meet the standards in terms of perioperative safety and oncological efficacy. Several randomized controlled studies and meta-analyses, and multi-institutional studies have shown comparable outcomes of robot-assisted radical cystectomy when compared with the conventional open approach. In this review, we aimed to describe the surgical technique of robot-assisted radical cystectomy and urinary diversion, and perioperative, pathological, oncological and functional outcomes.

Impact of Perioperative Multidisciplinary Rehabilitation Pathway on Early Outcomes after Robot-assisted Radical Cystectomy: A Matched Analysis.

OBJECTIVE: To investigate the effect of incorporating physical rehabilitation, nutrition and psychosocial care as part of the "NEEW" (Nutrition, Exercise, patient Education and Wellness) on perioperative outcomes after robot-assisted radical cystectomy. METHODS: Patients were divided into 2 groups: pathway group (NEEW in addition to enhanced recovery after surgery), vs prepathway group, before NEEW initiation (enhanced recovery after surgery only). Propensity score matching was performed (ratio 1:2 ratio). Perioperative outcomes were analyzed and compared. Multivariate analyses were modeled to assess for association between NEEW pathway and postoperative outcomes. RESULTS: One hundred and niney-two were included in the study: 64 patients (33%) in the pathway group vs 128 patients (67%) in the prepathway group. Pathway group had shorter median inpatient stay (5 vs 6 days, P <.01), faster bowel recovery (3 vs 4 days, P <.01), and better pain scores, and demonstrated fewer 30-day high grade complications (5% vs 16%, P = .02). On multivariate analysis, the NEEW pathway was associated with shorter hospital stay (1.75 days shorter), faster bowel recovery (1 day faster), longer functional mobility time (4 minutes longer) and less pain scores (average 1 point less). CONCLUSION: Standardized perioperative pathway with weekly multidisciplinary team meeting was associated with improved short-term perioperative outcomes after robot-assisted radical cystectomy.

The Effect of Complexity of the Surgical Field on Perioperative Outcomes of Robot-Assisted Radical Cystectomy.

OBJECTIVE: To report the outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation. METHODS: Retrospective review of our prospectively maintained database between 2005 and 2018. Patients were divided into 3 groups based on surgical complexity; Complexity grade 1 included patients who did not have any history of prior pelvic surgery or radiation (n = 323); Complexity grade 2 included those who had history of a single pelvic surgery or radiation (n = 186); and Complexity grade 3 included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n = 80). All groups were compared in terms of perioperative outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, ≥500 ml blood loss, 90-day complications, high grade complications, and readmissions. RESULTS: Complexity grades 2 and 3 exhibited higher 90-day complications compared to CG1 (CG3: 74%, CG1: 59%, CG2: 68%, P = .02), and high grade complications (CG3: 24%, CG1: 13%, CG2 18%, P = .03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day complications (OR 2.18, 95% CI 1.21-3.94, P <.01) but not significantly associated with higher rates of significant blood loss, longer operative time, 90-day high grade complications and readmissions. CONCLUSION: Patients with higher complexity of the surgical field exhibited more complications after robot-assisted radical cystectomy, but not readmissions.