Newswise — More than 60% of patients with bladder cancer are over 65 years old. For many of those patients, comorbidities preclude the possibility of open radical cystectomy. Robotic-assisted radical cystectomy offers a less-invasive alternative that confers several benefits, including less blood loss and 40-50% less pain, on average, than patients tend to experience with open cystectomy. In addition, recovery time averages about two to four weeks, compared with six to eight weeks for open cystectomy.
The surgeon controls the robot's movements from a console that provides magnified 3D vision of the operating field. Because the "arms" of the robot are slender and can swivel 360 degrees, it is ideally designed to move with precision inside the narrow pelvic cavity. Normal hand tremor is eliminated completely.
Approximately 100 robotic-assisted cystectomies have been performed at Roswell Park Cancer Institute (RPCI) since 2005, distinguishing RPCI as one of the world's premier academic institutions for the procedure. Khurshid Guru, MD, Director of Robotic Surgery, notes that all cystectomies are now performed robotically at RPCI.
Guru and members of his team reported in Urology (vol. 69, no. 3) on their experience with 20 consecutive patients who underwent robotic-assisted radical cystectomy, pelvic lymph node dissection and open urinary diversion for operable bladder cancer between October 2005-June 2006. Among other observations, the report noted that the mean patient age was 70 and the mean time to return to nonstrenuous activity was four weeks (20 weeks to strenuous activity).
Guru points out that the majority of candidates for open radical cystectomy are candidates for robotic-assisted cystectomy. "The initial results are promising," he says, "but the final place of the technique in surgical oncology will depend on long-term oncologic results and whether other premier institutions produce similar results."
RPCI also offers robotic prostatectomy and robotic surgery for the treatment of gynecologic cancers; for women with bladder cancer, the bladder, uterus and ovaries can be removed simultaneously.
Taking robotic surgery to the next level
Through Roswell Park Cancer Institute's Center for Robotic Surgery, surgical teams from as far away as Michigan and Pennsylvania are taking their robotic surgery programs to the next level. The RPCI training program offers two courses:
- A Remedial Program, to help surgical teams perfect their technique, identify problems and establish a baseline for performance. Guru says the remedial program has so far enabled four institutions "to decrease their operative time by between one and two hours." The course schedule includes three days at RPCI for a customized review of the institution's existing program, plus two days of observing robotic prostatectomies, followed by three days at the mentored institution for mentoring during two robotic prostatectomies, troubleshooting and development of a case plan and strategy, and post-course follow-up.
- A Robotic Cystectomy Program, for institutions that want to expand an existing robotic prostatectomy program to offer robotic cystectomy. The course schedule includes three days at RPCI for didactic training sessions, plus two days of observing robotic cystectomies, followed by three days at the mentored institution for mentoring during two robotic cystectomies, troubleshooting and development of a case plan and strategy, and post-course follow-up.
Guru says he and his team are also "working on simplifying the technique of robotic cystectomy for people who are trying to start a program."
To further refine the technology and technique, RPCI is collaborating with the University at Buffalo to develop more sophisticated technology for both training and real-world applications in robotic-assisted surgery. The partnership has already led to the creation of a new and unique Robotic Surgical Simulator (RoSS), a virtual-reality training system to help "medical students, residents and fellows interested in training in robotics to develop initial skills," explains Guru.
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