Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance

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Abstract
Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA OBJECTIVE: To compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). PATIENTS AND METHODS: From November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared. RESULTS: The mean EBL and transfusion requirements for standard and daVinci‐assisted cases was 1109 and 479 mL ( P = 0.002) and 2.7 and 1.6 units ( P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group ( P = 0.084). The mean operative duration was 638 and 507 min ( P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days ( P = 0.52). There was no difference in patient BMI between the groups ( P = 0.22). CONCLUSION: The daVinci‐assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings.

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