Robot-assisted extended pelvic lymphadenectomy

Purpose: To evaluate perioperative and pathologic outcomes of patients undergoing robot-assisted extended pelvic lymphadenectomy for bladder cancer. Materials and Methods: A retrospective chart review was performed for all 27 patients who underwent robotassisted radical cystectomy (RARC) and extended pelvic lymphadenectomy at Tulane University and Mayo Clinic Arizona between March 2005 and April 2007. Baseline demographic, perioperative, and pathologic data were evaluated. The bifurcation of the aorta was the proximal border of dissection in all patients. Results: There was a total of 27 patients, and all procedures were completed laparoscopically; all urinary diversions were constructed extracorporeally in RARC patients. The mean total operative time was 400 minutes, and mean blood loss was 277 mL. All patients had transitional-cell carcinoma in the bladder cancer group. The mean total lymph node count for the RARC group was 12.3 (range 7-20). There were no intraoperative complications, and 9 (33%) patients experienced postoperative complications. Conclusions: An extended pelvic lymphadenectomy can be reliably and safely performed robotically during RARC in the management of bladder cancer. The robotic system aids in performing a meticulous dissection and in adhering to sound oncologic principles.