Robot-assisted laparoscopic radical cystectomy with ileal conduit urinary diversion

Purpose: In this study, we detail our initial experience with robot-assisted laparoscopic radical cystectomy (RLRC) with ileal conduit urinary diversion (ICUD) and describe the stepwise surgical procedure. Materials and Methods: Four men underwent RLRC with extracorporeal ICUD for muscle invasive bladder cancer. RLRC was performed by a single surgeon using the da Vinci™ robot system (Intuitive Surgical, Sunnyvale, USA) with four robot arms. The surgical specimen was extracted through the sub-umbilical incision, and ICUD was also achieved through the sub-umbilical incision by extracorporeal technique. Results: The mean operative time was 355±49.8 minutes, and the mean estimated blood loss was 550±57.7ml. The mean hospital stay was 12±2.9 days. There were no major complications. On surgical pathology, one patient had pTis, one patient had pT1, and two patients had pT3 transitional cell carcinoma of the bladder. There were no positive surgical margins or lymph nodes. The mean number of dissected lymph nodes was 17±4.6 (range: 12-23). Conclusions: Despite limited experience, RLRC is a feasible procedure with minimal blood loss, shorter hospital stay, and may be an alternative to the open technique.