Laparoscopic Cystectomy and Robotic Assisted Cystectomy
Muscle invasive bladder cancer still has a high mortality rate. Radical cystectomy is the accepted first line therapy for muscle invasive and high risk urothelial bladder cancer. In order to decrease the procedure associated morbidity, minimal invasive operative techniques were introduced with increasing interest as well in the ablative and the reconstructive steps of the operation. Laparoscopic and robot assisted cystectomy in selected cases decreases blood loss respecting the oncological principles including the aim of negative margins and extended pelvic lymphadenectomy. Completely intracorporeal urinary tract reconstruction is feasible; however, it increases the total operative time and perioperative complication rate. So far, it seems that best results can be obtained by laparscopic and robot assisted extended lymph node dissection and radical cystectomy, while the upper urinary tract reconstruction is performed by limited open access. Pathological and cancer outcome are promising compared to open surgery. Still, the laparoscopic and robotic approaches for radical cystectomy are under clinical investigation. Long term outcome studies will answer the question, if selected patients profit from a minimal invasive approach.