V1883: Robotic Radical Cystectomy with Neoadjuvant Chemotherapy

Video

Introduction and Objectives
Robotic Radical Cystectomy (RRC) is a recent minimally invasive approach for the treatment of patients with invasive bladder cancer that has become popular among robotic surgeons over the last five years. It is still an evolving procedure and the use of neoadjuvant chemotherapy is an option that could offer some benefits. The objective is to present in this video our current technique in Robotic Radical Cystectomy after neoadjuvant chemotherapy and overview the landmarks as well as the main steps of the procedure.

Methods
We evaluated 12 consecutive patients whom underwent to RRC after using neoadjuvant chemotherapy. Age, BMI, operative time, estimated blood loss, hospital stay, pathological stage and complications rate were prospective collected and evaluated. Media and standard deviation were used to describe the results. A video with the main steps of the technique and results were presented.

Results
All were finished successfully, no conversion to laparoscopy or open surgery were necessary, mean age, BMI, operative time, hospital stay and blood loss were 63.3±5.6 years; 26.5±3.5; 260±31.8 min; 16.2±7.6 days and 562.5±262 cc respectively. _x000D_ Complications were presented in seven patients at 30 days and were classified as one patient Clavien 1, four patients clavien 2 and two patients clavien 3b. Most common pathological stage was pT3a. Downgrade was verified in 5 patients (41,6%). Also there were two patients pT1, one patient pT3b and one pT2a. Two patients had positive nodes (16,6%) and the average of lymph node was 16.5±4.6

Conclusions
Robotic radical cystectomy (RRC) is a feasible and safe procedure that offers the advantages of minimally invasive surgery to these type of patients. Also, RRC has shown oncological results comparable with open cystectomy. _x000D_ Neoadjuvant chemotherapy can be deployed without adding complexity to the procedure while it offers potential protection against systemic disease. It is still an evolving procedure and long term results are ongoing.

Funding: none