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Matched comparison of robotic assisted and open radical cystectomy: Experience from a single institution
Gillatt D. Pispati S. Bach C. Waine E. Koupparis A. Rowe E.
BJU International 2014;113 (Suppl 4):18.
Introduction Open radical cystectomy (ORC) remains the standard of care for muscle invasive bladder cancer. Robotically assisted radical cystectomy (RARC) has emerged as an alternative to ORC or laparoscopic surgery.
Patients and Methods An evaluation of RARC experience; non oncological outcomes. A comparison with an ORC series from the same institution. Dataset was from a prospective database of cystectomy patients from a single institution, complimented by case note and electronic record review. Outcomes were compared between cohorts of matched ORC from pre and post enhanced recovery and a separate group immediately post introduction of RARC.
Results 83 patients underwent RARC between January 2011 and May 2013. Conversion to open occurred in 8 (9.8%). 75 evaluable RARC patients were compared to 113 ORC (56 pre ERP and 57 post ERP). Demographics were similar between the three groups. Median length of stay fell from 16 days preERP, ORC to 9 for RARC. Blood loss, transfusion rates and Clavien 4 complications were all lower in the RARC group.
Conclusion Early experience with RARC suggest that improvements introduced by an enhanced recovery programme are further increased by RARC. Peri operative outcomes are superior for RARC over ORC. Ideally randomized trials would test the utility of RARC over standard ORC however there is evidence of benefit to a minimally invasive approach.