Analysis of the experience of robot-assisted cystectomy with various types of urine derivation

Abstract

BACKGROUND: Radical cystectomy is the main treatment for patients with muscle-invasive bladder cancer. Robot-assisted operations have become increasingly widespread; thus, an analysis of the results of using this technique is required.

AIM: To analyze our experience with robot-assisted radical cystectomy with different types of urinary diversion and compare the results to those obtained by other centers.

MATERIALS AND METHODS: The treatment results of 23 patients who underwent robot-assisted cystectomy with various types of urine derivation for bladder cancer between 2021 and 2024 were retrospectively analyzed.

RESULTS: Patients who had the Studer urinary reservoir formed were slightly younger and had better functional status and a higher body mass index. Additionally, there were more patients of the very high-risk cT1 stage. In patients who underwent ureterocutaneostomy, stages sT3–4 were more common. The average duration of the operation was 418.2 minutes. The longest duration (533.5 minutes) was observed during the formation of the urinary reservoir and the shortest (294.3 minutes) during ureterocutaneostomy. The smallest (200 ml) and largest (3,500 ml) blood loss occurred in patients who underwent Bricker ileal conduit formation. Ten conversions to open surgery (5 in the group of patients who had a urinary reservoir and 5 in ileoconduit) were noted. Nine patients developed postoperative complications, with seven exhibiting Clavien–Dindo grade IIIa–IIIb complications. The median follow-up was 19.7 months. Disease progression occurred in two (9%) patients. One patient died 1.5 years after surgery due to underlying disease progression.

CONCLUSIONS: Robot-assisted cystectomy is currently limited to specialized centers. The exchange of experience between them and its analysis are crucial to assess the immediate and long-term results of this technique and determine the category of patients who will benefit most from its application.

Keywords

bladder cancer / radical cystectomy / urine derivation / Studer / Bricker / ureterocutaneostomy robot-assisted surgery

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