Division of Robotic Urology, Saarland University, Kirrbergerstrasse 8, Homburg/Saar, Germany.
Int Braz J Urol. 2012 May-Jun;38(3):324-9. doi: 10.1590/s1677-55382012000300005.
Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications.
Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates.
Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min) and mean blood loss was 294 mL (range: 50-2000 mL). In 29 % of the cases with urothelial carcinoma the T-stage was pT1 or less, 38 % were pT2; 26 % and 7 % were classified as pT3 and pT4, respectively. 14 % of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1 %). Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11 % major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease.
Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.
我们分析了 91 例连续接受机器人辅助膀胱切除术患者的围手术期结果、病理分期和手术并发症。
2007 年至 2010 年，共 91 例患者（76 例男性和 15 例女性）接受了根治性机器人辅助膀胱切除术，其中 86 例为临床局限性膀胱癌，5 例为非尿路上皮肿瘤。我们分析了围手术期因素、住院时间、病理结果和并发症发生率。
平均年龄为 65.6 岁（范围 28-82 岁）。91 例患者中，68 例行回肠造口术，23 例行新膀胱术进行尿流改道。平均手术时间为 412 分钟（范围：243-618 分钟），平均失血量为 294 毫升（范围：50-2000 毫升）。在 29%的尿路上皮癌患者中，T 分期为 pT1 或更低，38%为 pT2；26%和 7%分别为 pT3 和 pT4。14%的病例有淋巴结阳性病变。平均切除的淋巴结数为 15 个（范围 4-33 个）。2 例（2.1%）切缘阳性。排气时间平均为 2.13 天，排便时间为 2.88 天，住院时间为 18.8 天（范围：10-33 天）。术后共发生 45 例并发症，其中 11%为严重并发症（Clavien 分级 3 级或以上）。平均随访 15 个月后，10 例患者出现疾病复发，6 例患者死于疾病。
我们的经验表明，机器人辅助根治性膀胱切除术治疗膀胱癌在手术和肿瘤学结果方面似乎非常有前途。
