Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Curr Opin Urol. 2013 Mar;23(2):135-40. doi: 10.1097/MOU.0b013e32835d4cda.
To provide discussion on several recently published case series describing complete intracorporeal robotic cystectomy. Are we making a complex and expensive procedure more challenging or are there patient benefits to be realized from a complete minimally invasive approach? We discuss how effective and cost-efficient a complete intracorporeal approach is, review the updates and comment on the future direction of robot-assisted radical cystectomy (RARC).
Several centers have recently reported a series of RARC with intracorporeal urinary diversion. Baseline demographics, complication rates and oncological outcome data were comparable to previously published open radical cystectomy series, as well as robotic cystectomy with extracorporeal urinary diversion series. In centers experienced in robotics, comparable outcomes were achieved early in the series with no significant difference in lymph node yields, positive surgical margin rates or complication rates. However, operation times and patient's length of stay (LOS) continued to improve, suggesting that aspect of the learning curve is longer than previously thought. Benefits such as decreased blood loss and reduced LOS, commonly associated with minimally invasive surgery, were seen and while costs of RARC remain prohibitive, reducing operative times and LOS will improve cost analysis.
RARC with totally intracorporeal urinary diversion is technically feasible with good early and intermediate-term oncological and complication rate results. High-volume centers with expertise can deliver a complete intracorporeal robotic cystectomy with no increase in the complication rates or additional costs compared to RARC with extracorporeal urinary diversion. Further long-term oncological and functional data and the results of prospective randomized controlled trials are both pending to confirm these findings.
提供最近发表的几篇描述完全经体内机器人膀胱切除术的病例系列，讨论我们是否使复杂和昂贵的手术更具挑战性，或者从完全微创方法中是否可以实现患者获益。我们讨论了完全经体内方法的有效性和成本效益，回顾了更新内容并对机器人辅助根治性膀胱切除术（RARC）的未来方向进行了评论。
最近几个中心报告了一系列具有经体内尿路改道的 RARC。基线人口统计学，并发症发生率和肿瘤学结果数据与先前发表的开放性根治性膀胱切除术系列以及具有经体外尿路改道的机器人膀胱切除术系列相似。在具有机器人经验的中心，在该系列的早期阶段即可实现可比的结果，在淋巴结产量，阳性手术切缘率或并发症发生率方面没有明显差异。但是，手术时间和患者住院时间（LOS）持续改善，表明学习曲线的某些方面比以前认为的要长。通常与微创手术相关的减少出血量和缩短 LOS 等益处已被看到，尽管 RARC 的成本仍然很高，但减少手术时间和 LOS 将改善成本分析。
具有完全经体内尿路改道的 RARC 在技术上是可行的，具有良好的早期和中期肿瘤学和并发症发生率结果。具有专业知识的高容量中心可以进行完全经体内机器人膀胱切除术，与具有经体外尿路改道的 RARC 相比，不会增加并发症发生率或增加成本。进一步的长期肿瘤学和功能数据以及前瞻性随机对照试验的结果都有待证实这些发现。
