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Objective: Robot-assisted radical cystectomy has the potential to cure patients from bladder cancer while offering the benefits of minimally invasive surgery. We sought to evaluate the learning curve for this technically demanding procedure., Materials and Methods: Robot-assisted radical cystectomy was attempted in 100 consecutive patients. An IRB-approved review of our robot-assisted radical cystectomy database was conducted. Total operative (OR) time, cystectomy time, pelvic lymph node dissection (PLND) time, estimated blood loss (EBL), margin positivity, complications, and length of hospital stay were compared among patients divided into 4 cohorts of increasing surgical experience. Scattergrams and continuous curves were plotted to develop a robotic cystectomy learning curve., Results: Overall OR time decreased from 375 minutes in cohort 1 to 352 minutes in cohort 4, with less than 1% change in OR time after case 16. Time from incision to bladder extirpation decreased from 187 minutes in cohort one to 165 minutes in cohort 4. Time for PLND increased from 44 minutes in cohort 1 to 77 minutes in cohort 4. Lymph node yield increased from 14 nodes in cohort 1 to 23 nodes in cohort 4. Positive surgical margins decreased from 4 patients in cohort 1 to 0 patient in cohort 4. The complication rate had no change from 9 patients in cohort 1 to 9 patients in cohort 4., Conclusion: Operative results and oncologic outcomes for robot-assisted radical cystectomy constantly improve as the technique evolves.

Background and Objectives: Obesity is a major comorbidity in the Western world and influences outcomes of patient care. A minimally invasive approach towards radical cystectomy has been increasing in popularity. We sought to determine the influence of body mass index (BMI) on robot-assisted radical cystectomy., Methods: Fifty-one consecutive patients underwent robot-assisted radical cystectomy for bladder cancer from October 2005 to April 2007 and were categorized into 3 groups based on their weight: normal (BMI <25), overweight (BMI=25 to 29) and obese (BMI= 30 to 39.9). Effect of BMI on intraoperative, pathologic, and postoperative outcomes was assessed by retrospective review of the robot-assisted radical cystectomy database., Results: Mean BMI was 28.0, and 71% of the patients were overweight or obese. BMI did not correlate with age, sex, or American Society of Anesthesiologists (ASA) score. Overweight and obese patients had similar operative times and estimated blood loss compared with patients with normal BMI. Overweight and obese patients with bulky disease (pT3-4) had significantly higher rates of positive surgical margins (P=0.05). Complication rates were similar., Conclusion: Robotic-assisted radical cystectomy can be considered for patients of all body mass indices. Wider excision should be performed in patients with higher BMI.

The majority of bladder cancer patients who develop brain metastasis have widely disseminated disease. Isolated cerebellar metastasis in patients with transional cell carcinoma (TCC) of the bladder is a rare event. We present the case of a patient with organ-confined bladder cancer who developed isolated cerebellar metastasis.