Robot-Assisted Cystectomy: Strengths and Weaknesses

IntroductionIn recent years, minimally invasive techniques such as purely robot-assisted radical cystectomy (RARC) have been suggested as a new surgical approach to muscle-invasive bladder cancer. In this article we review the review the intra- and perioperative results as well as the short- and intermediate-term oncologic results of RARC.Materials and methodsBased on the work recently presented at the European Society of Oncological Urology's 2011 meeting, we reviewed the available literature on RARC. A PubMed literature search was conducted in March 2011 to review English-language articles published from 2000 onward on RARC.ResultsThe literature supports that lymph node yield, learning curve, and intermediate-term oncologic outcomes related to RARC are not different from open surgery. Several articles described the advantages of robotic approach in terms of estimated blood loss, hospital stay, and perioperative outcomes. Operative time remains significantly longer than in the open procedure. A low rate of positive surgical margins may be achieved with RARC, comparable with the open approach. Intracorporeal urinary diversion is likely to represent the future direction for RARC, even if it requires great technical expertise. Due to the relatively recent introduction of the robotic approach in the bladder cancer arena, long-term oncologic data are not yet available.ConclusionsRARC represents a safe and viable treatment for muscle-invasive bladder cancer. However, there is an urgent need for large, prospective, randomised trials that will establish the potential advantages and limitation of RARC compared with the open approach.