Bladder cancer is a serious health risk, both functionally and oncologically, and represents an ever-increasing socioeconomic burden. It is now the sixth most common type of cancer in the US and the tenth most common cancer in the world, with its incidence increasing steadily worldwide each year.

In terms of surgical treatments, radical cystectomy with pelvic lymphadenectomy is considered the gold standard for muscle-invasive bladder cancer, however, due to its inevitably extensive surgical nature and the high incidence of multiple comorbidities among patients, it is associated with high rates of perioperative morbidity and mortality. Minimally invasive surgical techniques have gained popularity in various fields due to their potential to reduce surgical morbidity and shorten hospital length of stay. In particular, robotically assisted radical cystectomy, since its introduction in 2003, has been an option aimed at improving perioperative outcomes and survival.

So where are we today?

In terms of oncological outcomes, the robotic versus the open approach, recently in the largest comparative analysis using data from the Swedish National Bladder Cancer Registry, was associated with a higher performance in lymph node removal, a component directly related to the oncological efficacy of the operation.

Radical cystectomy due to its unavoidably extensive surgical nature often presents with peri- and post-operative metabolic, infectious, genitourinary and gastrointestinal complications, which are recognized as major causes of readmission and occur most frequently in the first two weeks after hospital discharge.

Regarding peri- and postoperative outcomes, a recent randomized study from the United Kingdom demonstrated that the robotic cystectomy group, compared to open, showed a significant increase in days out of hospital during the postoperative 90 days, fewer thromboembolic complications (1, 9% vs. 8.3%,) and wound complications (5.6% vs. 16.0%), was associated with lower estimated blood loss (150 mL vs. 700 mL) and lower risk of Clavien–Dindo grade III or higher complications.

Bladder cancer patients are usually elderly, have lower functional capacity, and have multiple comorbidities. Thus, recovery of quality of life after radical cystectomy is a critical issue in the field of urology.

Robotic surgery undoubtedly offers the benefits of less morbidity, shorter hospital stays, faster recovery, and fewer narcotic analgesic requirements, all of which contribute to increased patient quality of life.

Health-related quality of life and functional capacity were shown to be superior in terms of early recovery and physical well-being after robotic cystectomy compared to open.

in conclusion

With current data, robotic-assisted radical cystectomy for bladder cancer compared with open is associated with lower estimated blood loss, lower rates of intraoperative transfusion, shorter hospital stay, lower risk of postoperative major complications, and lower readmission rates within 90 days. In terms of quality of life, robotics was superior in some respects in terms of early restoration of health and physical well-being.