Robot-Assisted Laparoscopic Nerve-Sparing Radical Cystoprostatectomy with Bilateral Extended Lymph Node Dissection and Intracorporeal Studer Pouch Construction: Outcomes of First 12 Cases

Purpose: We report our initial experience with robot-assisted laparoscopic neurovascular bundle (NVB) sparing radical cystoprostatectomy (RALRC), bilateral extended lymph node dissection (BELND) with intracorporeal Studer pouch construction for invasive bladder cancer. Patients and Methods: After initially performing >50 cases of robot-assisted laparoscopic radical prostatectomies (RALRP), between December 2009 and April 2010, we performed 12 RALRC procedures with BELND. Bilateral (n = 10) and unilateral (n = 1) intrafascial NVB preservation was performed in 11 patients; nonnerve-sparing RALRC was performed in 1 patient. Results: Patient characteristics and surgical and postoperative parameters were mean patient age (y): 60 (43-80); American Society of Anesthesiologists score: 2 (1-3); body mass index (kg/m(2)): 24.5 (19.3-31.2); preoperative International Index of Erectile Function (IIEF) score: 25 (5-65); operative time (h): 10 (8.1-11.5); intraoperative blood loss (mL): 455 (100-700); lymph node (LN) yield: 21.3 (8-38); hospital stay (d): 10.7 (9-16); lodge drain removal (d): 10 (9-15). Five patients received neoadjuvant chemotherapy. Surgical margins were negative in all patients. Postoperative pathologic stages were: pT(0) (n = 2), pT(1) (n = 1), pT(2a) (n = 2), pT(2b) (n = 2), pT(3a) (n = 4), and pT(4a) (n = 1). Positive LNs and incidental prostate cancer were detected in five and three patients, respectively. Perioperative death rate was zero. Right external iliac vein injury occurred in one patient during the performance of BELND; surgery was converted to an open procedure and the injury was repaired. Colonic fistula developed in one patient at postoperative day 40; the patient died from cardiac disease at day 60. At a mean follow-up of 7.1 +/- 2.3 months, three patients died from metastatic disease. Of the available seven patients, six were fully continent and one had mild daytime incontinence. Conclusions: Although RALRC with bilateral intrafascial NVB preservation, BELND, and intracorporeal Studer pouch formation is a complex procedure, it can be performed with excellent short-term surgical and pathological outcomes and satisfactory functional results after considerable experience gained with RALRP procedures.