Robotic-assisted intracorporeal radical cystectomy with modified ileal conduit reduces ureteroileal anastomotic stenosis risk: a comparative study with laparoscopic surgery.
Robotic-assisted cystectomy may reduce complications like stenosis and blood loss compared to laparoscopic surgery, but longer operative times and further trials are needed to confirm benefits.
Where it sits
this study against the rest of the cjc-1295 corpusSummary and findings
The study compared robotic-assisted intracorporeal radical cystectomy with a modified ileal conduit to laparoscopic surgery in 69 bladder cancer patients. The robotic group showed lower rates of ureteroileal anastomotic stenosis and postoperative complications but had longer operative times. The findings suggest potential benefits of the robotic approach, though further trials are needed.
Abstract
<h4>Background</h4>This study aims to evaluate the clinical efficacy of an innovative robot-assisted totally intracorporeal antecolic modified ileal conduit procedure (robotic group) versus laparoscopic surgery (laparoscopic group) in bladder cancer patients, providing evidence for optimizing urinary diversion strategies and reducing associated complications.<h4>Methods</h4>From Jan 2023 to Oct 2025, 69 patients undergoing total cystectomy by one surgeon were enrolled; 23 received robotic surgery (KangDuo SR2000) and 46 laparoscopic. Baseline, perioperative, and postoperative data were collected. Primary endpoint: radiologically confirmed ureteroileal anastomotic stenosis; secondary: postoperative ileus, new upper urinary tract stones, 90‑day complications, and recovery indicators.<h4>Results</h4>Baseline characteristics were similar between groups (all <i>p</i> > 0.05). The robotic group had significantly lower stenosis (0% vs 15.22%, <i>p</i> = 0.043), ileus (8.70% vs 28.26%, <i>p</i> = 0.043), and new stones (4.35% vs 21.74%, <i>p</i> = 0.046). Intraoperative blood loss was reduced (98.70±28.97 vs 155.00±65.76 mL, <i>p</i> < 0.001), but operative time was longer (249.7±19.7 vs 199.6±22.7 min, <i>p</i> < 0.001). No significant differences were found in time to bowel function recovery or 90‑day complication rate.<h4>Conclusion</h4>Robot‑assisted intracorporeal radical cystectomy with modified ileal conduit ensures perioperative safety, lowers long‑term complications and blood loss despite longer operative time, suggesting it is a promising alternative; however, prospective randomized controlled trials are needed to confirm these findings.
Background
The study addresses the optimization of urinary diversion strategies in bladder cancer patients undergoing radical cystectomy. Previous research has highlighted complications such as ureteroileal anastomotic stenosis associated with these procedures. This study evaluates whether a robotic-assisted approach can reduce such complications compared to traditional laparoscopic methods.
Methods
This was a comparative study conducted from January 2023 to October 2025 involving 69 bladder cancer patients undergoing total cystectomy by a single surgeon. Twenty-three patients received robotic-assisted surgery using the KangDuo SR2000 system, while 46 underwent laparoscopic surgery. The primary endpoint was the incidence of ureteroileal anastomotic stenosis, with secondary endpoints including postoperative ileus, new upper urinary tract stones, 90-day complications, and recovery indicators.
Results
The robotic group experienced 0% ureteroileal anastomotic stenosis compared to 15.22% in the laparoscopic group, with a p-value of 0.043. Postoperative ileus occurred in 8.70% of the robotic group versus 28.26% of the laparoscopic group, also with a p-value of 0.043. New upper urinary tract stones were observed in 4.35% of the robotic group compared to 21.74% in the laparoscopic group, with a p-value of 0.046. Intraoperative blood loss was significantly lower in the robotic group at 98.70±28.97 mL compared to 155.00±65.76 mL in the laparoscopic group, with a p-value of less than 0.001. However, the operative time was longer for the robotic group at 249.7±19.7 minutes versus 199.6±22.7 minutes for the laparoscopic group, with a p-value of less than 0.001.
Interpretation
The study suggests that robotic-assisted intracorporeal radical cystectomy may offer advantages in reducing certain complications compared to laparoscopic surgery. The reduction in ureteroileal anastomotic stenosis and other complications is statistically significant, but the clinical significance should be weighed against the longer operative time. These findings align with some previous reports of robotic surgery benefits but require confirmation through larger, randomized controlled trials to establish clinical relevance.
Key findings
- 0% stenosis in robotic group vs 15.22% in laparoscopic, p=0.043
- 8.70% ileus in robotic group vs 28.26% in laparoscopic, p=0.043
- 4.35% new stones in robotic group vs 21.74% in laparoscopic, p=0.046
- 98.70±28.97 mL blood loss in robotic group vs 155.00±65.76 mL in laparoscopic, p<0.001
- 249.7±19.7 min operative time in robotic group vs 199.6±22.7 min in laparoscopic, p<0.001
Limitations
- small n=69
- non-randomized design
- single-surgeon study
- longer operative time in robotic group