Comparative Outcomes and Perioperative Complications of Robotic Vs Open Cystoplasty and Complex Reconstructions

Abstract

Objective: To compare perioperative and surgical outcomes in a 2-center, 2-surgeon open vs robotic augmentation ileocystoplasty.

Materials and methods: We reviewed patients undergoing augmentation ileocystoplasty open vs robotically between 2008 and 2014 at 2 centers. We compared the groups' preoperative characteristics, perioperative outcomes, complications, and interim functional outcomes.

Results: The cohort consisted of 17 and 15 patients with median follow-up of 45 and 46 months, in open and robotic groups, respectively. Median operative time (incision to closure) was longer in the robotic cohort (265 minutes vs 623 minutes, P < .001). Median length of stay (7 days vs 6 days, P = .335), time to diet (4 days vs 4 days, P = .125), and mean intravenous morphine equivalents/kg (1.23 mg/kg vs 0.56 mg/kg, P = .091) were comparable between groups for open and robotic, respectively. There were 4/17 (23.5%) of the open cohort who had an epidural for an average of 93 hours. All patients had stable or improved hydronephrosis postoperatively. Major reoperations, such as for bowel obstruction, were required in 2/17 (11.7%) in the open group and none in the robotic cohort. Minor stomal complications requiring skin-level revision or endoscopic procedure occurred in 4/17 (23.5%) in the robotic cohort and 2 (11.7%) in the open group.

Conclusion: We reveal equivalent rates of complications, length of stay, and blood loss for augmentation cystoplasty among appropriately matched controls. Prolonged operative times of the robotic cohort did not lead to additional morbidity for patients. Further steps to reduce morbidity and additional investigations should be undertaken prior to widespread adoption of the intracorporeal technique in experienced robotic centers.