1 衛生福利部部立桃園醫院 泌尿外科；2 臺北榮民總醫院 泌尿部；3 國立陽明醫學大學醫學院 泌尿學科
Early cases analysis of robotic-assisted radical cystectomy in Taipei veterans general hospital
Cheng-Yen Chiang1,2,3, Hsiao-Jen Chung2,3, Yi-Hsiu huang2,3, Alex T.L. Lin2,3, Kuan-Kuo Chen2,3
1 Urology Department, Taoyuan General Hospital, Ministry of Health and Welfare; 2 Department of Urology, Taipei Veterans General Hospital; 3 Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Purpose: We analyzed the perioperative data and outcome of the early cases who underwent robotic-assisted radical cystectomy with reconstructive surgeries at our hospital.
Materials and Methods: We included patients who underwent robotic-assisted radical cystectomy with reconstructive surgeries with ileal conduit and ileal neobladder during 2011 to 2014. All the procedures were performed by transperitoneal methods. Reconstructive procedures were performed with extracorporeal methods. Patients who underwent ileal neobladder reconstruction had a re-docking procedure to perform anastomosis with da Vinci Si Surgical System. Perioperative data such as age, gender, ASA score of the patients, operative time, estimated blood loss, blood transfusion, pathology, and surgical margin status were collected prospectively. Postoperative complications within postoperative 30 days were also collected prospectively for further analysis.
Results: Total 16 patients, 15 males and 1 female, underwent robotic-assisted radical cystectomy. Mean age was 62.7 ± 8.4 and mean ASA score was 2. Four patients underwent ileal conduit reconstruction and the other 12 patients had ileal neobladder reconstruction. Mean console time and operative time were 412 and 720 minutes, respectively. Median estimated blood loss was 390 mL (range from 100 to 2200 mL). Two (12.5%) patients underwent blood transfusion during operation. Mean nodal yield was 20 (range from 8 to 38) and 7 (43.8%) patients had lymph node metastasis. Only one (6.3%) patient had positive surgical margin. Mean postoperative hospital stay was 19.4 days. Clavien grade I, II, III, IV and V complications within postoperative 30 days were 0%, 18.8%, 6.3%, 0% and 0%, respectively. Rectal injury during the operation was noted in one patient and was repaired intraoperatively without any sequela.
Robotic-assisted radical cystectomy is a feasible and safe procedure for invasive bladder cancer. With experience, operative efficiency and outcomes will be improved.