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Introduction of robot‐assisted radical cystectomy within an established enhanced recovery programme
Author(s) -
Miller Catherine,
Campain Nicholas J.,
Dbeis Rachel,
Daugherty Mark,
Batchelor Nicholas,
Waine Elizabeth,
McGrath John S.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13702
Subject(s) - cystectomy , medicine , urinary diversion , surgery , bladder cancer , complication , general surgery , cancer
Objectives To describe the implementation phase of a robot‐assisted radical cystectomy ( RARC ) programme including side‐effect profiles and impact on length of stay ( LOS ). Patients and Methods In all, 114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 [ileal conduit (97 patients) and orthotopic neobladder (17)]. Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied. All patients were managed on the Exeter Enhanced Recovery Pathway ( ERP ) in a unit where embedded enhanced recovery practice was already established. Data were collected prospectively on the national cystectomy registry – the British Association of Urological Surgeons ( BAUS ) Complex Operations Dataset. Results RARC was technically feasible in all but one case. The mean operating time was 3–5 h with an overall transfusion rate of 8.8%. There were higher‐grade complications (Clavien–Dindo grade III – IV ) in 18.4% of patients, with a 30‐day mortality rate of 0.9%. The median (range) LOS after RARC was 7 (3–68) days, with a re‐admission rate of 18.4%. Conclusions The present series shows that RARC can be safely implemented in a unit experienced in robot‐assisted surgery ( RAS ). Case‐selection in this setting is not deemed necessary. There are benefits in terms of lower transfusion rates and reduced LOS . The side‐effect profile appears to differ from that of open RC , and despite the fact that complication rate is equivalent; ‘technical’ complications are over‐represented in the RAS group. As such, they should improve with experience, recognition, and modification of surgical technique. ERP s can be safely applied to all patients undergoing RARC to maximise the benefits of minimally invasive surgery.