Robotic-assisted radical cystectomy with complete intracorporal diversion: Initial experience in a tertiary teaching hospital

Objective: The aim of this study was to report the outcomes from robotic-assisted radical cystectomy (RARC) at an Australian public teaching hospital since the introduction of this technique in 2012. Methods: A retrospective analysis was conducted on perioperative and pathological outcomes from a consecutive series of 43 patients who underwent RARC for bladder cancer between 2012 and 2020 at Nepean Public Hospital. Results: Median operative time was 352 minutes for 32 (74.4%) patients undergoing construction of an ileal conduit, 499 minutes for nine (20.9%) patients undergoing construction of a neo-bladder and 239 minutes for two (4.7%) patients undergoing percutaneous urostomy. Median estimated blood loss was 500 mL, and median length of stay was 12 days. Complications within 60 days of any grade occurred in 63.4% of patients, and major complications (Clavien-Dindo >= Grade III) occurred in 20.9% of patients. The median number of lymph nodes removed was 17. Positive surgical margins occurred in 11.6% of patients overall, all in patients with T3 and above disease. Neo-adjuvant chemotherapy was utilised in 34.9% of patients overall and in 71.4% of patients with muscle-invasive urothelial cancer. Conclusion: The perioperative and pathological outcomes from RARC at our institution are comparable to the international literature.