Best Practices in Robot-assisted Radical Cystectomy and Urinary Reconstruction: Recommendations of the Pasadena Consensus Panel

March 1, 2015

By: Timothy G. Wilson a, Khurshid Guru b, Raymond C. Rosen c, Peter Wiklund d, Magnus Annerstedt e, Bernard H. Bochner f, Kevin G. Chan a, Francesco Montorsi g, Alexandre Mottrie h, Declan Murphy i, Giacomo Novara j, James O. Peabody k, Joan Palou Redorta l, Eila C. Skinner m, George Thalmann n, Arnulf Stenzl o, Bertram Yuh a and James Catto p

European Urology, Volume 67 Issue 3, March 2015, Pages 363-375

Published online: 01 March 2015

Abstract

Context
Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes.

Objective
A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference.

Evidence acquisition
A systematic review of the literature was performed in agreement with the PRISMA statement.

Evidence synthesis
Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques.

Conclusions
RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference.

Patient summary
Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.

Download full publication

Previous Article
Unconditional Love: St. Joseph Health Pet Therapy Programs Comfort Patients
Unconditional Love: St. Joseph Health Pet Therapy Programs Comfort Patients

Benefits of pet therapy programs at hospitals.

Next Article
Providence Saint John's and Tarzana Medical Center Named Among America's Best Hospitals

Providence Saint John's Health Center was named today among the nation’s top 50 hospitals, the only Califor...