Robot-assisted radical cystectomy: Technique and results

Introduction. Robot-assisted radical cystectomy (RARC) is increasingly adopted as a minimally invasive alternative to open surgery for muscle-invasive bladder cancer. The optimal urinary diversion technique remains a subject of debate.

The aim of the study is to compare perioperative outcomes, complication rates and quality of life after RARC with Bricker ileal conduit versus Studer orthotopic neobladder.

Materials and methods. A retrospective review of 93 patients who underwent RARC with Bricker ileal conduit (n = 74) or Studer orthotopic neobladder (n = 19) at the A.S. Loginov Moscow Clinical Research Center in 2018-2024 was performed. Operative time, blood loss, in-hospital days, Clavien-Dindo complications and EORTC QLQ-BLM30 quality of life scores 6 and 12 months after the surgery were assessed.

Results. Mean operative time for Studer orthotopic neobladder (462.28 ± 75.66 min) was longer than for Bricker ileal conduit (361.96 ± 46.84 min, p <0.05). The volume of blood loss was also higher for orthotopic diversion (292.22 ± 76.22 mL versus 216.64 ± 104.62 mL, p = 0.001). Complication rates per the Clavien-Dindo classification were similar (p >0.05). Physical, emotional and social well-being scores favored the Studer group 6 months after the intervention but equalized by 12 months (p >0.05).

Conclusion. Studer neobladder is characterized by longer operative time and higher blood loss compared to Bricker technique with similar complication rate. Orthotopic diversion provides superior early postoperative quality of life, but the differences disappear after 12 months.

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