V05-10: Robotic Assisted Radical Cystourethrectomy
To demonstrate a technique of en bloc primary urethrectomy with robotic-assisted radical cystectomy (RARC) for patients with evidence of bladder neck or urethral disease.
This video shows a technique for robotic assisted radical cystourethrectomy in patients with bladder neck or urethral disease. The urethrectomy was performed through a perineal incision with the specimen delivered into the abdomen and excised en bloc with the cystectomy specimen. We analysed the peri-operative and pathological outcomes of 10 patients who had robotic assisted radical cystourethrectomy to a group of 15 patients having radical cystectomy without urethrectomy during the same period and a group of 8 patients who had open radical cystourethrectomy prior to the introduction of the robotic program. In the comparison, all patients had an ileal conduit as the form of diversion.
There were no significant differences between the outcomes of the robotic radical cystourethrectomy group and the robotic cystectomy only or open radical cystourethrectomy group complication rate, readmission rate, lymph node yields or positive margins. Operative duration was significantly increased in the robotic cystourethrectomy group compared to the other groups. Estimated blood loss and length of stay were not significantly different to the robotic cystectomy only group however it was significantly decreased compared to the open radical cystourethrectomy group.
The addition of concurrent primary urethrectomy at the time of robotic-assisted radical cystectomy appears to be have similar peri-operative and pathological outcomes to robotic-assisted radical cystectomy only, albeit with an increased operative time. There are potential benefits for the robotic approach over open radical cystourethrectomy regarding blood loss and length of stay although with an increased operative time.