Introduction: Recently, robotic approaches to cystectomy have been reported. Application of these minimally-invasive approaches to female patients has been limited. We describe our approach and outcomes with a robotic-assisted laparoscopic anterior pelvic exenteration for bladder cancer in the female.

Methods: Ten women underwent robotic-assisted laparoscopic anterior pelvic exenteration and extracorporeal urinary diversion for clinically-localized bladder cancer. The stepwise operative procedure is described in detail. Outcome measures evaluated in this series included operative variables, hospital recovery, pathologic outcomes, and complication rate.

Results: Mean age was 68.4 years (61-79 years). Seven patients underwent ileal conduit diversion and 3 patients underwent an orthotopic neobladder. In all cases the urinary diversion was performed extracorporeally. Mean OR time was 4.6 hours, mean surgical blood loss was 215 ml. On surgical pathology, 5 patients were <=pT2, 3 patients pT3, and 2 patients N+. In no case was a positive surgical margins, and in one case there as inadvertent entry into the bladder. Mean number of lymph nodes removed was 19 (range 12-34). Mean time to flatus was 1.9 days, and bowel movement 2.4 days, and time to discharge 4.9 days. Five patients were discharged on POD#4, 3 patients on POD#5, 1 on POD#6, and 1 on POD#8. There were 2 post-operative complications (20%) in 2 patients.

Conclusion: Our initial experience with robotic-assisted laparoscopic anterior pelvic exenteration appears to be favorable with acceptable operative, pathological, and short-term clinical outcomes. Certainly, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical and oncologic option.