Questions and concerns of robotic approaches to bladder cancer surgery

The use of the surgical robot in performing radical cystectomy was initiated with the hope of decreasing the morbidity and mortality associated with surgical treatment of bladder cancer. The benefits of minimally invasive techniques are well documented for several other surgical operations, and these benefits will ideally be realized by patients receiving robotic cystectomy rather than its open counterpart. While the potential benefits of using the surgical robot for radical cystectomy are well defined, the universal acceptance of this technique has been met with some resistance because of concerns about unique issues and complications surrounding the application of robotic surgery. The concerns discussed herein include lymph node dissection, surgical margin status, urinary diversions, ureteral stricture rates, tumor spillage and port site metastases, the learning curve with robotic surgery, associated costs, and the potential benefits. While the questions/concerns surrounding robotic surgery are well defined, many of the answers are yet unclear. More studies with long-term follow-up are needed to determine the true safety, efficacy, and actual benefits of robotic radical cystectomy.