V1863: Robotic Radical Cystectomy. Tips and tricks in Pelvic Lymphadenectomy and Neurovascular bundles preservation

Video

Introduction and Objectives
Bladder cancer is the fourth most common tumor in men in the United States and in Europe it represents 8.7% of the total cancers and 5.9% of total deaths for cancer. Robot-assisted procedures are increasingly being performed as minimally invasive surgical approaches. We report some tips and tricks in of robot assisted radical cystoprostatectomy with focus on pelvic lymphadenectomy and neurovascular bundle preservation.

Methods
Between 2001 to 2012, there were 218 radical cystectomies performed at Institut Montsouris. Since 2009, 90% has been done by minimally invasive approach. NVB preservation technique was performed in 57 cases. The present study is a combination of (1) a literature review, (2) presentation of a robotic assisted radical cystoprostatectomy, in which some tricks were made to solve some difficult steps of the procedure.

Results
We show strategies to get complete lymph node packages, including solution of challenging situation that can occur during lymphadenectomy. We also present the key principles of our nerve sparing technique together with our anatomical approach to the neurovascular bundles. Results obtained with the application of these lessons have led to continuous improvement of peri- and postoperative outcomes.

Conclusions
PLND is an essential part of the surgical treatment of bladder cancer for its staging, curative, and prognostic role. To date, robot-assisted PLND can produce comparable results to open surgery. This feasibility technique of a robot-assisted, nerve-sparing radical cystoprostatectomy shows that the procedure combines the oncological concepts of open surgery with the technical benefits of robotic surgery.

Funding: none