Robotic cystectomy may cut blood loss, hospital stay

Patients with muscle-invasive bladder cancer who undergo robot-assisted radical cystectomy may experience less blood loss and shorter hospital stays than those undergoing open cystectomy, results of a new randomized study indicate.

The study, to be published in the February 2013 Journal of Urology, found no significant differences in treatment outcomes between the procedures.

The goal of the single-institution trial was to evaluate the benefits of robotic versus open surgery in patients with invasive bladder cancer. The trial, conducted between July 2009 and June 2011, was performed at the University of Texas Health Science Center at San Antonio. Primary eligibility was based on candidacy for an open or robotic approach at the discretion of the treating surgeon.

Forty patients were randomized individually and equally to either an open or robot-assisted cystectomy group using a computer randomization program. Investigators evaluated five surgery outcome factors: estimated blood loss, operative time from incision to closure, transfusion requirements, time to return of bowel function, and length of stay.

The robotic group experienced significantly decreased blood loss, accompanied by a trend toward faster return of bowel function, fewer hospitalizations beyond 5 days, and fewer transfusions.

"The strength of our study is the prospective randomized nature that eliminates selection biases that may have been present in prior retrospective analyses," said lead author Dipen J. Parekh, MD, formerly of the University of Texas Health Science Center who is currently with the University of Miami Miller School of Medicine. "We also believe that our study demonstrates that a prospective randomized trial comparing traditional open and robotic approaches in bladder cancer is possible."