V8-14: Robotic Salvage Cystectomy: Tips and Tricks
VideoIntroductions and Objectives
Robotic cystectomy has continued to become an increasingly accepted and utilized surgical approach. To our knowledge, there have been no published series of robotic cystectomy in the salvage setting, as patients who have had prior therapy for advanced prostate or bladder cancer are typically offered open salvage cystectomy.
Since 2013, we have performed robotic salvage cystectomies after a variety of prior treatment modalities including cryotherapy, brachytherapy, external beam radiotherapy, and radical prostatectomy. We followed the basic steps of a robotic cystectomy as is done in the non-salvage setting, with particular emphasis being placed on the posterior and urethral dissections. All patients underwent an intracorporeal ileal conduit urinary diversion.
We performed seven robotic salvage cystectomies at our institution. Mean total operative time was 6.5 hours (range 4.8-8.4 hours) and mean estimated blood loss was 300 mL (range 200-500 mL). There were no bowel injuries or gastrointestinal fistulae.
Robotic salvage cystectomy, though challenging, can be safely done after a variety of prior primary therapies. More data is needed to determine long-term oncologic and functional outcomes.