Background/Objectives: While robot-assisted radical cystectomy (RARC) has shown potential benefits over open radical cystectomy (ORC), such as reduced blood loss and quicker recovery, its adoption has been limited because of its complexity and long learning curve, especially for urinary diversion. We assessed whether a RARC program with fully intracorporeal urinary diversion could be safely implemented in a hospital with no prior experience in RARC, but with expertise in ORC and other robotic surgeries. We also compared perioperative outcomes and complications between RARC and ORC during the implementation phase. Methods: This retrospective comparative study included 50 consecutive patients who underwent RARC between June 2023 and January 2025 and 50 patients previously treated with ORC. All RARC cases were performed with intracorporeal urinary diversion. A structured proctoring program guided two surgeons through a stepwise training approach by an expert RARC surgeon. Perioperative outcomes and 90-day complications were compared. Results: All RARC procedures were completed fully intracorporeally with no conversions to open surgery. Compared with ORC, RARC was associated with significantly shorter operative times (for ileal conduit diversion) and hospital stays, lower estimated blood loss, and fewer postoperative complications. There were no differences in intraoperative complications. Worst single grade ≥ 3 complications were significantly less frequent in the RARC than the ORC group (11 [11%] versus 21 [21%],p= 0.045). On multivariable analysis, the robotic approach independently predicted fewer any-grade complications (odds ratio 0.81, 95% confidence intervals 0.65–0.95,p= 0.01). Conclusions: A RARC program can be safely and effectively implemented in a previously RARC-naïve centre with existing surgical expertise. The robotic approach offers clear perioperative benefits and may represent a favourable alternative to open surgery.
背景/目的：尽管机器人辅助根治性膀胱切除术（RARC）相较于开放根治性膀胱切除术（ORC）已显示出潜在优势，如减少失血量和加快恢复速度，但其应用因其复杂性及较长的学习曲线（尤其在尿流改道方面）而受到限制。本研究评估了在既往无RARC经验但具备ORC及其他机器人手术专业知识的医院中，实施完全体内尿流改道的RARC项目是否安全可行。同时，我们比较了实施阶段RARC与ORC的围手术期结果及并发症情况。方法：这项回顾性比较研究纳入了2023年6月至2025年1月期间连续接受RARC的50例患者，以及先前接受ORC治疗的50例患者。所有RARC病例均采用体内尿流改道。通过结构化的指导计划，由一位经验丰富的RARC外科专家指导两名外科医生采用分步培训方法。比较了两组的围手术期结果和90天并发症。结果：所有RARC手术均完全在体内完成，无中转开放手术。与ORC相比，RARC（针对回肠通道尿流改道）的手术时间、住院时间显著缩短，估计失血量更少，术后并发症也更少。两组术中并发症无差异。RARC组发生最严重单级≥3级并发症的频率显著低于ORC组（11例 [11%] 对 21例 [21%]，p=0.045）。多变量分析显示，机器人手术方式是减少任何级别并发症的独立预测因素（比值比0.81，95%置信区间0.65–0.95，p=0.01）。结论：在具备现有外科专业知识但既往无RARC经验的中心，可以安全有效地实施RARC项目。机器人手术方式具有明确的围手术期优势，可能成为开放手术的有利替代方案。
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