Evidence Shows Robot-Assisted Cystectomy Safe, Effective

Longer-term, controlled studies needed to evaluate the procedure in management of bladder cancer

MONDAY, Nov. 7 (HealthDay News) -- Robotic-assisted radical cystectomy (RARC) appears to be a safe and effective alternative to open radical cystectomy (ORC) for management of muscle-invasive bladder cancer, according to a review published in the November issue of Urology.

Marcelo A. Orvieto, M.D., from the University of Chicago Medical Center, and colleagues reviewed available literature pertaining to RARC. A total of 24 studies with 350 cases were included. They described the current experience and status of RARC and compared it with the ORC series.

The investigators found that, at present, the conversion rates for RARC are acceptable, ranging from 0 to 3 percent. RARC should currently be offered mainly to patients with low-volume, nonbulky, organ-confined disease, without a history of pelvic radiation. Adequate port placement is a vital step for successful procedure outcome. More than 75 percent of all RARCs have been performed in men, but the surgical technique for both men and women aims to replicate and follow the same oncological principles, as the open approach. Very few RARC cases have been carried out with intracorporeal bowel reconstruction, but accumulating experience and additional refinement of the technique are likely to make the procedure more widespread. Compared to laparoscopy, RARC has a shorter learning curve and reduced estimated blood loss (EBL). Compared to ORC, RARC has significantly reduced mean EBL, shorter hospital stay, and longer operating time with comparable complications.

"This review of published RARC series affirms the need for prospective, long-term, controlled studies to adequately evaluate the role of robotics in bladder cancer surgery," the authors write.

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