[Intervention planning in modern renal surgery]. / Moderne Interventionsplanung in der Nierenchirurgie.

BACKGROUND: Three-dimensional (3D) reconstruction in renal surgery offers significant benefits in planning of the operation itself, in patient education and training fellows. OBJECTIVE: The goal was to study the possible application and use of 3D reconstruction in modern renal surgery. METHODS: A literature search in PubMed using keywords "3D" and "renal surgery" within the last 10 years of publication was performed. RESULTS: The search revealed 655 articles among them 53 reviews. Relevant for this article were 120 articles which included 14 reviews. The publication statistics showed a strong increase in the last 10 years which may reflect the increasing application and demand for 3D technology in the field of renal surgery. Especially in robot-assisted minimally invasive surgery applications, the use of 3D technology was studied more often. The technical standards are not yet uniform and 3D printing in complex renal surgery remains cost- and time-intensive. Nevertheless, the results of the pioneering clinical studies showed positive results, and 3D technology can be used not only in planning the operation, but in patient education and also the training of fellows and staff. A limitation to more complex cases seems to be sensible for this is still a costly tool. To identify complex cases in renal surgery, the established renometric scoring systems should be used more broadly in daily practice to identify patients who would profit most from this technique. CONCLUSION: In complex renal surgery, 3D reconstruction and modelling is rational; furthermore, it can be useful in patient education and in training of fellows.

[New aspects in the treatment of localized renal cell carcinoma]. / Neue Aspekte zur Therapie des lokal begrenzten Nierenzellkarzinoms.

BACKGROUND: Localized renal cell carcinoma is increasingly relevant in daily urological practice due to earlier diagnosis and higher life expectancy. OBJECTIVES: To analyze and compare current treatment evidence for localized renal cell carcinoma regarding new aspects of nephron-sparing surgery, the different surgical approaches and focal therapy. METHODS: A systematic search was performed to identify relevant publications from 2018 and 2019. RESULTS: Prospective randomized trials comparing nephrectomy with partial nephrectomy, the three different surgical approaches with each other, and focal therapy with surgery are still lacking. Positive effects on survival by partial nephrectomy could be demonstrated, even though partial nephrectomy has a higher morbidity than radical nephrectomy. Older patients (>75 years) with advanced localized renal cell carcinoma did not appear to benefit from partial nephrectomy so far, but minimally invasive surgical approaches are underrepresented in such studies. Minimally invasive partial nephrectomy is superior to the open approach, and robot-assisted partial nephrectomy has better results than laparoscopy. Focal therapy of kidney tumors is technically safe and feasible, but relevant comparisons with partial nephrectomy are still lacking. CONCLUSIONS: Partial nephrectomy is still the gold standard treatment for localized renal cell carcinoma, it should be preferably performed by a robot-assisted approach. Focal therapy can serve as an alternative in highly selected cases.

[Robot-assisted kidney transplantation]. / Roboterassistierte Nierentransplantation.

BACKGROUND: Robot-assisted surgery has become widely adopted in urology due to advantages in comparison with laparoscopic or open approaches. Robot-assisted living kidney transplantation is one of the most challenging procedures in urology regarding technical, but also psychological and ethical aspects, and is currently routinely performed in two German departments. OBJECTIVES: The goal was to analyze and compare current evidence and experiences of robot-assisted living kidney transplantation in Europe and in Germany. MATERIALS AND METHODS: A systematic search was performed to identify relevant publications. They were compared with latest results from two German academic centers (Halle and Homburg/Saar). RESULTS: In 2015, robot-assisted living kidney transplantation was performed for the first time in Europe. Since then, 8 academic centers have established this procedure. Until today, more than 180 robot-assisted kidney transplantations have been performed. Short- and mid-term results have proven to be excellent with low complication rates. Apart from 3 transplant losses because of arterial thrombosis and 5 surgical re-explorations due to hematoma, no other noteworthy complications occurred. There was only 1 lymphocele. The median blood loss was 150 ml and kidney function after 1 year was unchanged in comparison with postoperative day 30. CONCLUSIONS: Robot-assisted living kidney transplantation is not inferior to the open approach. Even superiority is not unlikely because problematic situations such as obese patients or complex vascular anatomy can be handled safely. In particular, the development of lymphocele and wound healing disorders appear to be significantly decreased compared to conventional surgery.

[T-cell immune responses in chronic inflammatory diseases of the nasal mucosa]. / T-Zell-Immunreaktionen bei chronisch entzündlichen Erkrankungen der nasalen Schleimhäute.

Acute rhinosinusitis and chronic rhinosinusitis are inflammatory diseases of the mucosal membranes due to mislead immunological reactions to aeroallergens. T­cells are divided into different groups based on their cytokine secretion: T­helper type 1 (Th1) and type 2 (Th2) cells. The allergic immune response is caused by activation of specific Th2 cells. With specific immunotherapy, the mislead hyperactivated "allergic" immune response is reduced to a reaction within the normal range. The inflammatory forms of chronic rhinosinusitis are called endotypes, and, in the future, could enable a targeted, pathomechanistic therapy. These endotype-based treatment approaches target specific signaling pathways that have already shown good effects for chronic rhinosinusitis with nasal polyps using monoclonal antibodies. However, so far, only selected patients with non-rhinologic indications, off-label treatments, or in clinical trials have benefited from these treatments.

[Trivialization of prostate cancer? : Stage shift and possible causes]. / Bagatellisierung des Prostatakarzinoms? : Stadien-Shift und mögliche Ursachen.

BACKGROUND: According to the strongly negative grade D recommendation of the U.S. Preventive Services Task Force in 2012, the prostate-specific antigen (PSA) test was not only not recommended but was also warned against. As a result in the USA there was a stage shift towards more advanced tumor stages under the newly detected prostate cancers; however, in contrast to the highly questionable American PLCO study, the European ERSPC study showed a clear reduction in prostate cancer-related mortality. OBJECTIVE: In this patient cohort it was investigated whether the tumor stage distribution in curatively treated prostate cancer has significantly changed, whether this has an influence on the perioperative results and complication rates and how these changes could have occurred. MATERIAL AND METHODS: Patients after radical prostatectomy from 2008 to 2010 were compared to those from 2017. Demographic data, intraoperative courses, perioperative and postoperative complications and histopathological results were compared. RESULTS: A total of 1276 operations were analyzed. Preoperative PSA levels showed a significant increase in 2017 (10.5 ± 13.4 ng/ml vs. 8.4 ± 9.1 ng/ml, p = 0.032). The pathological staging revealed a 20% increase in T3 tumors (49.4% versus 29.0%, p < 0.001). Correspondingly, moderately and poorly differentiated cancers and therefore those with higher aggressiveness were significantly more frequent with 11.2% (p < 0.001) and 10.4% (p < 0.001), respectively. The number of patients with lymph node metastases at prostatectomy even increased fourfold (4.5% vs. 16.9%, p < 0.001). CONCLUSION: In the radical prostatectomy group, there was a shift to unfavorable and metastatic tumor stages. This negative trend seems largely to be caused by a lower acceptance of early detection by means of PSA determination.

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BACKGROUND: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC). METHODS: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test. RESULTS: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3-367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04). CONCLUSIONS: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

Robot-sewn ileoileal anastomosis during robot-assisted cystectomy.

PURPOSE: To analyze the feasibility and perioperative results of patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis. METHODS: This is a mono-centric analysis of perioperative data from 48 consecutive patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis. Data include the preoperative variables, operative and postoperative course and complication rates related to bowel anastomosis. End points were time spent for anastomosis and intra- and postoperative complication rates. RESULTS: Median operating time was 23.0 (13-60) min for the ileoileal anastomosis. Median overall operating time was 295 (200-780) min, with a median of 282 (200-418) min and 414.0 (225-780) min for the ileum conduit (N = 35) and ileal neobladder (N = 13). Two patients developed paralytic ileus; in another patient acute peritonitis occurred, but was caused by urinary leakage and therefore unrelated to the bowel anastomosis. No anastomotic leakage was noticed. Costs for the robot-sewn anastomosis was 8€ compared to 1250€ for a stapled anastomosis which was performed in previous cases. Limitations are the non-comparative nature of the analysis and the limited number of patients. CONCLUSIONS: Robot-sewn ileoileal anastomosis is feasible with low complication rates. Compared to the stapled anastomosis, a robot-sewn ileoileal anastomosis may serve as an alternative and cost-saving approach.

[Management of ureteral strictures and hydronephrosis]. / Management von Harnleiterstrikturen und Harnstauung.

Patients who develop hydronephrosis due to an acute cause often have colic-like pain but hydronephrosis secondary to a chronic cause is often asymptomatic. Ureteral obstruction can be due to a variety of intrinsic and extrinsic causes, such as trauma, radiation, iatrogenic injury, urolithiasis, malignancies and congenital causes. Management planning is dictated by the underlying cause, patient comorbidity and life expectancy. Malignant ureteral obstructions can be managed with segmental metal stents with advantages in the quality of life and provide an alternative to long-term treatment with a DJ stent. Endoscopic balloon dilatation and endoureterotomy are options for benign ureteral strictures up to 2 cm in length. For longer benign strictures there are a number of reconstructive techniques, which can also be performed by laparoscopic or robot-assisted approaches at specialized centers.

[Radical prostatectomy. Detection and management of intra- and postoperative complications]. / Die radikale Prostatektomie. Intra- und postoperative Komplikationen erkennen und behandeln.

Radical prostatectomy is the most common treatment for organ-confined prostate cancer. Performed without complications and limitations, surgery will allow complete removal of the tumor and, therefore, cure the patient. Operative techniques have been improved during the last few decades to reduce invasiveness of the procedure. Furthermore, optimized perioperative management has shortened hospital stay. To ensure rapid recovery of each patient, early detection of complications is highly relevant. Herein, different scenarios for peri- and postoperative complications are described, and recommendations for best practice solutions are reviewed.

[First experience in the thyroid and parathyroid surgery using the da Vinci® system]. / Erste Erfahrungen in der Schilddrüsen- und Nebenschilddrüsenchirurgie mit dem da Vinci®-System.

BACKGROUND: Endoscopic surgery for the treatment of thyroid and parathyroid pathologies is gaining increasing attention. The da Vinci® system has been already widely used in different fields of medicine including recently thyroid and parathyroid surgery. Herein we report our first experiences in endoscopic surgery of thyroid and parathyroid pathologies using the da Vinci® system. MATERIAL AND METHODS: 8 patients presenting with struma nodosa in 6 cases and parathyroid adenomas in 2 cases have been treated using the da Vinci® system at the ENT department of Homburg/Saar University. RESULTS: The skin incision to introduce the instruments with the da Vinci® system were axilar or at the lateral segment of the clavicle. The neurovascular structures like inferior laryngeal nerve as well as the pathologies were clearly 3-dimensional visualized in all 8 cases. No paralysis of the vocal cord was observed. All patients had in histological examination a benign pathology. CONCLUSIONS: The endoscopic surgery of the thyroid and parathyroid gland can be performed using the da Vinci® system and offers an excellent, intraoperative, 3-dimensional visualization of the neurovascular structures. Additionally the da Vinci® system enables skin incisions within considerable distance from the thyroid and parathyroid gland.

Experiencia inicial con una serie de adrenalectomía laparoscópica asistida por robot / Initial experience of a series of robotic-assisted laparoscopic adrenalectomy

Objetivos: Presentamos nuestra experiencia inicial utilizando la adrenalectomía laparoscópica robótica en el tratamiento quirúrgico de las masas suprarrenales. Material y métodos: Entre octubre de 2009 y octubre de 2011 fueron operados en nuestra institución un total de 18 pacientes (11 mujeres y 7 hombres) con diagnóstico de masa tumoral adrenal funcionante o no funcionante. Evaluamos variables quirúrgicas, el tiempo de recuperación intrahospitalario, los hallazgos patológicos y las complicaciones peri y postoperatorias. Resultados: La edad media de la población intervenida fue 51,2 años (rango: 18-81), el promedio de puntuación ASA 2,11 (rango: 1-4) y el IMC 27,0 (rango: 18,8-36,1). De los 18 pacientes 11 fueron operados del lado izquierdo y 7 del derecho. El tiempo medio de cirugía fue 150 minutos (rango: 84-329) y el sangrado intraoperatorio 121 ml (rango: 10-1.500), con una pérdida media de hemoglobina y de hematocrito de 2,11g/dl y 6,33%, respectivamente. Dos pacientes fueron convertidos a cirugía convencional. Los factores que influyeron en la conversión quirúrgica fueron: tamaño tumoral (>10cm), peso tumoral (>100 g), feocromocitoma activo y localización izquierda del tumor. Se extirparon 7 adenomas corticales funcionantes, 6 tumores suprarrenales metastásicos, 3 feocromocitomas y 2 tumores incidentales. El tamaño medio del tumor fue 5,39 cm (rango: 3-15). La mediana de la estancia hospitalaria fue de 6 días (rango: 4-14). Un total de 5 pacientes presentaron complicaciones perioperatorias. De éstos solo uno (5%) tuvo complicaciones mayores (Clavien III). El seguimiento medio fue de 6 meses (rango: 2-24). Conclusiones: La tecnología robótica para la realización de adrenalectomías laparoscópicas es una opción válida para el tratamiento de los tumores suprarrenales. En nuestra experiencia, con una curva de aprendizaje relativamente corta, permite reducir los tiempos de tratamiento hospitalario, así como las complicaciones intra y postoperatorias, sin afectar los resultados oncológicos y funcionales postoperatorios (AU)

Objectives: We present our initial experience using robotic-assisted laparoscopic adrenalectomy in the surgical treatment of adrenal masses. Material and methods: A total of 18 patients (11 women and 7 men) diagnosed of a functioning or non-functioning adrenal tumor mass were operated on in our facilities between October 2009 and October 2011. Surgical variables, intra-hospital recovery time, pathological findings and peri- and post-operatory findings were evaluated. Results: Mean age of the population intervened was 51.2 years (range 18-81), average ASA score 2.11 (range 1-4) and BMI 27.0 (range 18.8-36.1). Of the 18 patients, 11 were operated on the left side and 7 on the right. Mean surgery time was 150 (range 84-329) min and intra-operatory bleeding 121 (range 10-1500) ml, with a mean loss of hemoglobin and hematocrits of 2.11g/dl and 6.33%, respectively. Two patients were converted to conventional surgery. The factors influencing surgical conversion were: normal size (>10cm), tumor weight (>100g.), active pheochromocytoma and left localization of the tumor. Seven functioning cortical adenomas, 6 metastatic adrenal tumors, 3 pheochromocytoma and 2 incidental tumors were excised. Mean tumor size was 5.39 (range 3-15) cm. Median hospital stay was 6 days (range 4-14). Five patients had peri-operatory complication. Of these, only one (5%) had major complications (Clavien III). Mean follow-up was 6 months (range 2-24). Conclusions: Robotic technology for laparoscopic adrenalectomies is a valid option for adrenal tumor treatment. In our experience with a relatively short learning curve, it makes it possible to reduce hospital treatment times and the intra- and post-operatory complications, without affecting the oncological and post-operatory functional results (AU)

[Initial experience of a series of robotic-assisted laparoscopic adrenalectomy]. / Experiencia inicial con una serie de adrenalectomía laparoscópica asistida por robot.

OBJECTIVES: We present our initial experience using robotic-assisted laparoscopic adrenalectomy in the surgical treatment of adrenal masses. MATERIAL AND METHODS: A total of 18 patients (11 women and 7 men) diagnosed of a functioning or non-functioning adrenal tumor mass were operated on in our facilities between October 2009 and October 2011. Surgical variables, intra-hospital recovery time, pathological findings and peri- and post-operatory findings were evaluated. RESULTS: Mean age of the population intervened was 51.2 years (range 18-81), average ASA score 2.11 (range 1-4) and BMI 27.0 (range 18.8-36.1). Of the 18 patients, 11 were operated on the left side and 7 on the right. Mean surgery time was 150 (range 84-329) min and intra-operatory bleeding 121 (range 10-1500) ml, with a mean loss of hemoglobin and hematocrits of 2.11g/dl and 6.33%, respectively. Two patients were converted to conventional surgery. The factors influencing surgical conversion were: normal size (>10cm), tumor weight (>100g.), active pheochromocytoma and left localization of the tumor. Seven functioning cortical adenomas, 6 metastatic adrenal tumors, 3 pheochromocytoma and 2 incidental tumors were excised. Mean tumor size was 5.39 (range 3-15) cm. Median hospital stay was 6 days (range 4-14). Five patients had peri-operatory complication. Of these, only one (5%) had major complications (Clavien III). Mean follow-up was 6 months (range 2-24). CONCLUSIONS: Robotic technology for laparoscopic adrenalectomies is a valid option for adrenal tumor treatment. In our experience with a relatively short learning curve, it makes it possible to reduce hospital treatment times and the intra- and post-operatory complications, without affecting the oncological and post-operatory functional results.

[Nephron-sparing surgery 2012]. / Organerhaltende Nierenchirurgie 2012.

Nephron-sparing surgery is considered to be the standard surgery for small renal masses. There is a large socioeconomic and oncological relevance in such a decision, especially since tumour incidence as well as average life expectancy increases, also triggered by better diagnostic quality. The present review highlights the current state of nephron sparing-surgery, evaluates different surgical approaches and gives perspectives on the future developments and scientific investigations required. In conclusion, nephron-sparing surgery has been well studied and different approaches have shown high safety profiles with oncological results comparable to those of radical nephrectomy. Nephron -sparing surgery provides decisive advantages in long-term survival and patient morbidity, especially concerning chronic renal failure rates. Therefore, whenever feasible, a renal mass should be considered for nephron-sparing surgery.

[Pyeloplasty - pro robotic-assisted]. / Nierenbeckenplastik - pro robotisch.

Open pyeloplasty is still the gold standard in the treatment of ureteropelvic junction (UPJ) obstructions in many clinics. Similar functional results could be shown in diverse publications using conventional laparoscopic pyeloplasty (CLPP). The reconstruction of the UPJ is the main step during this type of surgery and constitutes a major challenge to surgeons working with minimally invasive techniques. The more complex the surgery the more obvious the benefits of robotic assistance (seven grades of freedom, 3D view etc.) in comparison to conventional laparoscopy. Thus robotic assistance is optimally suitable for pyeloplasty. The robotic-assisted laparoscopic pyeloplasty (RLPP) facilitates intracorporeal suturing and shortens the learning curve. Residents benefit from this shortened learning curve. Disorders caused by the non-physiological position during conventional laparoscopy are avoided during RLPP, which is an additionally benefit. Robotics also seem to be the optimum platform for the future of reconstructive LESS. The RLPP rather than the CLPP technique has therefore the potential to replace open pyeloplasty as the gold standard in treatment of UPJ.

[Radical cystectomy - pro robotic]. / Radikale Zystektomie - pro robotisch.

The standard therapy for muscle invasive bladder cancer is radical cystectomy and urinary diversion. For open surgery this procedure has notable perioperative morbidity. Performing laparoscopic cystectomy can reduce this morbidity. So far it remains unclear, whether the oncologic outcome of the laparoscopic approach is comparable to open surgery or not due to a lack of long-term follow-up data. Important surgical steps, such as extended lymphadenectomy, sparing of the neurovascular bundle for preservation of potency, preparation of the urethra for orthotopic neobladder and intracorporeal construction of a urinary diversion can be achieved much more easily with a robot-assisted approach than with conventional laparoscopy. Furthermore, the learning curve for robot-assisted cystectomy is much steeper. Therefore, if a laparoscopic cystectomy is performed, it should be performed using a robot-assisted approach.

[Resection of metastases from prostate cancer]. / Metastasenresektion beim Prostatakarzinom.

Surgical resection of a solitary or a limited number of metastases is a controversy in patients with prostate cancer that is increasingly being discussed. The improved accuracy of the detection of local or distant recurrences after primary treatment using modern imaging techniques including choline PET/CT led to an increased demand for salvage surgical procedures. Apart from the resection of synchronous metastases at the time of radical prostatectomy the oncological efficacy of a salvage lymphadenectomy or a salvage resection of visceral or osseous metastases remains to be proven. Here, the available data covering the different clinical scenarios for the resection of metastases in prostate cancer and recommendations of recently published guidelines are reviewed.

[Robotic medicine in Germany: quo vadis?]. / Robotische Medizin in Deutschland: quo vadis?

Today, one can hardly imagine the medical daily routine without computer-assisted systems, although their benefit usually is not investigated by prospective randomised trials. While in the industrial working environment computer-assisted systems are thoroughly accepted because of their precision and endurance, in medicine there are fierce debates about their use at considerably high costs. At least the perioperative advantages (e.g. less blood loss, shorter period of hospitalization), to a large extent, are beyond dispute. The high costs may be compensated by a higher volume of treated patients. Only the treatment of a higher volume of patients will lead to a reduction of infrastructure costs per case. On the other hand, only a large number of cases ensure the achievement of skills to handle such a complex system. This, in return, reduces the chance of the occurrence of complications and shorter operation times will lead to economic advantages.

Update on relapses in unilateral nephroblastoma registered in 3 consecutive SIOP/GPOH studies - a report from the GPOH-nephroblastoma study group.

INTRODUCTION: Treatment and stratification of progressive/relapsed unilateral nephroblastoma (PD) has significantly evolved over the last 20 years. Early PD (≤ 6 months), initial high risk histology, local stage III, multiple site PD and stage IV have been implemented as high risk classification factors and novel drugs have been introduced. PATIENTS AND METHODS: We analysed all 251 patients having had a unilateral nephroblastoma (Stage I-IV) and progressive disease who had been treated according to SIOP9/GPO (n = 77), SIOP93-1/GPOH (n = 93) and SIOP2001/GPOH (n = 81) initially. RESULTS: 3y-overall survival (OS) increased from 43% to 61% and 59% respectively (both p<0.01). 3y-OS for localized stage I-III rose from 43% to 65% and 68% respectively while only little improvement can be seen for initial stage IV patients with 43%, 53% and 44% respectively. Multivariate analysis confirmed high risk histology, local stage III, shorter time to PD, combined relapse as independent risk factors. 26 patients had received high-dose chemotherapy showing 64% 3y-OS compared to 54% for all non-transplanted (p=0.11). CONCLUSION: Structuring the treatment of progressive nephroblastoma as well as introducing new drugs have improved the outcome significantly. However improvement is depending on the specific risk profile. Very high risk tumours are often resistant to conventional treatment, hence an international uniform treatment concept is needed to achieve conclusive results in this small group.

Cistectomía radical laparoscópica asistida por robot: evaluación de los resultados funcionales y oncológicos / Robotic-Assisted Laparoscopic Radical Cystectomy: Evaluation of Functional and Oncological Results

Objetivo: presentamos nuestra experiencia en cistectomía radical robótica informando sobre los resultados quirúrgicos, tanto desde el punto de vista oncológico como funcional. Material y método: entre enero de 2007 y agosto de 2010 fueron operados en nuestra institución un total de 84 pacientes (70 hombres y 14 mujeres) con diagnóstico histopatológico de cáncer de vejiga invasor no metastásico. Evaluamos variables quirúrgicas, el tiempo de recuperación intrahospitalario, los hallazgos patológicos y las complicaciones peri y postoperatorias. Resultados: la edad media de la población en estudio fue 65,6 años (rango: 28-82). En 62 pacientes se realizó derivación urinaria con ureteroileostomía tipo Wallace, los 22 pacientes restantes recibieron una neovejiga ileal tipo Studer. El tiempo promedio de cirugía fue de 261 minutos (rango: 243-618) y la pérdida promedio de sangre intraoperatoria fue de 298ml (rango 50-2.000). Un 29, 38, 26 y 7% presentaron estadios histopatológicos postoperatorios pT1, pT2, pT3 y pT4, respectivamente. El 15% de los pacientes operados presentó metástasis locales a nivel ganglionar. El número de ganglios linfáticos resecados por procedimiento quirúrgico fue de 14,47 (rango: 1-33). En dos casos (2,4%) se registraron márgenes quirúrgicos positivos. El tiempo promedio de aparición de flatos fue 2,12 días, evacuación intestinal postoperatoria 2,87 y alta médica 17,710-33. Un total de 45 pacientes presentaron complicaciones perioperatorias. De estos sólo un 11,9% tuvo complicaciones mayores (Clavien III o mayor) que necesitaron de un tratamiento más invasivo. El tiempo promedio de seguimiento fue de 16,7 meses. Durante ese período 10 pacientes (11%) presentaron recidiva del tumor vesical, de los cuales dos (2,38%) fallecieron. Conclusión: nuestra experiencia con cistectomía radical robótica en el tratamiento del cáncer de vejiga sugiere que en manos adecuadas este procedimiento proporciona resultados quirúrgicos y patológicos aceptables (AU)

Purpose: radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. We report our experience with 84 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes and surgical complications. Materials and methods: a total of 84 consecutive patients (70 male and 14 female) underwent robotic radical cystectomy and urinary diversion at our institution from January 2007 to August 2010 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes and complication rate. Results: mean age of this cohort was 65.5 years (range 28 to 82). Of the patients 62 underwent ileal conduit diversion, 22 received a neobladder. Mean operating room time for all patients was 261min. (range: 243-618min.) and mean surgical blood loss was 298ml (range: 50-2000ml). 29% of the cases were pT1 or less disease, 38% were pT2, 26% and 7% were pT3 and T4 disease respectively, 15% were node positive. Mean number of lymph nodes removed was 15 (range 1 to 33). In 2 cases (2.4%) there was a positive surgical margin. Mean days to flatus were 2.12, bowel movement 2.87 and discharge home 17.7 (range: 10-33). There were 45 postoperative complications with 11.9% having a major complication (Clavien grade 3 or higher). At a mean followup of 16.7 months 10 patients (11%) had disease recurrence and 2 died of disease. Conclusions: our experience with robotic radical cystectomy for the treatment of bladder cancer suggests that in proper hands this procedure provides acceptable surgical and pathological outcomes (AU)