Anatomic Robot-Assisted Radical Cystectomy

Robot-assisted laparoscopic radical cystectomy (RARC) was initially described in 2003 and has since been gaining popularity as a minimally invasive technique in both men and women of all ages with muscle-invasive bladder cancer, selected cases of high-risk nonmuscle invasive disease, and selected cases with advanced disease. 1,2 RARC offers the patient the benefits of less blood loss, shorter hospital stay, less postoperative pain, and early recuperation with improved cosmesis. For a surgeon, it facilitates fine dissection and intracorporeal suturing in a visually conducive three-dimensional environment with ergonomic comfort. For residents, fellows, and novice surgeons, RARC can shorten the learning curve in comparison with pure laparoscopic procedures. In selected cases, nerve-sparing, vaginal-sparing, uterus-sparing, and prostate-sparing RARC can be undertaken to maintain functional outcomes and fertility. We aim to succinctly describe the indications and contraindications, preoperative workup, preoperative preparation, instrumentation needed, surgical steps, postoperative care, and management of intraoperative and postoperative complications. New advances in technique and a summary of the major published series for RARC are also reported.