Robot-assisted anterior exenteration: Technique and initial series

Background and Purpose: The feasibility of robot-assisted anterior exenteration (RAAE) in women has been reported but not well established. We report our experience with seven patients, providing perioperative data, hospital course, and immediate oncologic outcomes. Patients and Methods: From November 2005 to June 2006, seven consecutive patients with a mean age of 70 years (range 59-82 years) underwent RAAE for bladder cancer. Urinary diversion consisted of an ileal conduit in six patients and neobladder in one. The mean body mass index and ASA scores were 25 (range 20-36) and 2 (range 2-3), respectively. Data were collected prospectively on intraoperative performance, oncologic status, and postoperative outcomes. Results: The mean operative times for RAAE, pelvic lymph-node dissection, and ileal-conduit creation were 227 minutes (range 142-350 minutes), 48 minutes (range 35-80 minutes), and 132 minutes (range 80-255 minutes), respectively. The time needed for neobladder formation was 3 hours. The time required for anastomosis between the neobladder and the urethra with robotic assistance was 1 hour and 43 minutes, including time for closure of the mini-incision, redocking, and port placement. No case was converted to open surgery. All the surgical specimens were removed vaginally. There were no intraoperative complications or need for intraoperative blood transfusions. The only postoperative complication was an episode of pyelonephritis, which was managed successfully with antibiotics. The average times to return to normal and strenuous activity were 3.7 and 7.3 weeks, respectively. Final pathology examination revealed T₀N₀, TisN₀, T₁N₀, T_2bN₀, T_3aN₀, T_3aN₁, and T ₄N₃ disease. Six patients had negative surgical margins, whereas the patient with T₄N₃ disease had positive vaginal margins. Conclusion: Robot-assisted anterior exenteration can be offered safely to women. The long-term oncologic outcomes and experience of others will define its place in urologic oncology.