The possibilities of robotic technologies in the treatment of patients with muscular-invasive bladder cancer: robot-assisted cystectomy literature review

Introduction. The standardized incidence of bladder cancer (BC) is 6,41 per 100,000populations, and there is an upward trend. In 20-30% of patients, muscle-invasive BC (MIBC) is detected at the initial diagnosis. In 20% of patients with non-muscularly invasive BC (NMIBC), despite the treatment, muscle invasion is later detected. Radical cystectomy (RC) is considered to be the main method of treating MIBC. Due to the lack of large randomized trials to date evaluating the long-term oncological and functional results of open (ORC) and robot-assisted radical cystectomy (RARC), the question of choosing between these two surgical interventions remains open. In order to systematize the available research on this problem, we have made this literature review. Materials and methods. The search for relevant publications in the PubMed and e-library databases was carried out using the keywords «robotic cystectomy», «muscle-invasive bladder cancer», «minimally invasive surgery», «robot-assisted cystectomy», «muscle-invasive blade cancer», «mini-invasive surgery». As a result of the search, 83 sources were selected, which were included in this literature review. The analysis of the literature evaluated the criteria for selecting patients for robotic cystectomy, the features of their preoperative preparation, oncological results and complications of ORC and RARC, as well as the quality of life of patients after these surgical interventions and the economic aspects of their use. Results and discussion. The first RARC was performed in 2003 by M. Menon et al. The main advantages of RARC compared to ORC, proved as a result of the conducted studies, include lower intraoperative blood loss and the need for blood transfusion. There was no statistically significant difference between RARC and ORC in terms of the number and severity of complications, the radicality of surgery, the frequency of relapses and progression of BC, as well as the survival rate and quality of life of patients. The duration and cost of the ORC is less. Conclusions. The introduction of RARC into clinical practice allowed minimizing the trauma of access during ORC, eliminating the inconveniences of the laparoscopic approach, and optimizing the postoperative period. Further research is required on the following aspects of RARC: selection of patients for this surgical intervention, choice of the method of urine derivation during the operation, the possibility of using organ-sparing techniques and its economic feasibility.