Misra Sidharth, Bisht Rahul, Motiwala Zainab Yusufali, Puniyani Aditya, Desai Arusha, Duddu Nihar, Carbin Danny Darlington
University of Texas Southwestern Medical Center, Texas, USA.
Armed Forces Medical College, Pune, Maharashtra, India.
J Robot Surg. 2025 Sep 5;19(1):560. doi: 10.1007/s11701-025-02740-4.
The gold standard treatment for muscle-invasive bladder cancer (MIBC) still is radical cystectomy. Thanks to better peri-operative results than open surgery, robotic-assisted radical cystectomy (RARC) has become somewhat well-known. Though they are linked with problems like infection, pain, and higher healthcare expenses, conventionally ureteral stents are used during urinary diversion to minimize anastomotic leaks and strictures. This has spurred growing interest in stent-less urinary diversion methods. To assess the present data on the feasibility, safety, efficacy, and clinical outcomes of stent-less robotic-assisted radical cystectomy and decide if the stent-less technique is ready for general clinical use, a comprehensive literature review was conducted using PubMed, EMBASE, and Cochrane databases with search terms: "robotic cystectomy," "ureteral stent," "stent-less urinary diversion," "complications," and "postoperative outcomes." Studies comparing outcomes of stented and stent-less RARC published in peer-reviewed journals were reviewed, with exclusion of pediatric studies and those exclusively focusing on open cystectomy. With respect to anastomotic integrity, complication rates, patient comfort, and cost-effectiveness, emerging studies show that stent-less RARC is viable in suitably selected patients and yields either comparable or possibly better results. Widespread acceptance is now limited, nonetheless, by variation in surgical procedures and institutional experience. Stent-less robotic cystectomy is interesting with possible benefits in terms of lower complications and higher patient satisfaction. Larger prospective randomized controlled trials and standardized surgical techniques are required, nonetheless, before suggesting regular use in clinical practice.
肌肉浸润性膀胱癌（MIBC）的金标准治疗方法仍然是根治性膀胱切除术。由于围手术期结果优于开放手术，机器人辅助根治性膀胱切除术（RARC）已逐渐为人所知。尽管传统的输尿管支架与感染、疼痛和更高的医疗费用等问题有关，但在尿液改道过程中仍使用输尿管支架以尽量减少吻合口漏和狭窄。这激发了人们对无支架尿液改道方法的兴趣日益浓厚。为了评估目前关于无支架机器人辅助根治性膀胱切除术的可行性、安全性、有效性和临床结果的数据，并确定无支架技术是否已准备好用于一般临床，我们使用PubMed、EMBASE和Cochrane数据库进行了全面的文献综述，搜索词为：“机器人膀胱切除术”、“输尿管支架”、“无支架尿液改道”、“并发症”和“术后结果”。我们回顾了在同行评审期刊上发表的比较有支架和无支架RARC结果的研究，排除了儿科研究和那些专门关注开放膀胱切除术的研究。关于吻合口完整性、并发症发生率、患者舒适度和成本效益，新出现的研究表明，无支架RARC在适当选择的患者中是可行的，并且产生的结果相当或可能更好。然而，目前广泛接受度受到手术程序和机构经验差异的限制。无支架机器人膀胱切除术很有意义，在降低并发症和提高患者满意度方面可能有好处。然而，在建议在临床实践中常规使用之前，还需要更大规模的前瞻性随机对照试验和标准化的手术技术。
