An anesthetic perspective on transoperative complications in open versus robot-assisted radical cystectomy: a five-year retrospective study

Background

Radical cystectomy remains the standard treatment for invasive bladder cancer, yet it carries significant anesthetic risks. While robot-assisted surgery has gained popularity, data comparing its anesthetic implications to those of open surgery are limited. This study aimed to compare the incidence of transoperative complications between the two techniques.

Methods

We retrospectively analyzed 44 patients who underwent open (n = 29) or robot-assisted (n = 15) radical cystectomy in a university hospital between 2019 and 2024. Data were collected on American Society of Anesthesiologists (ASA) physical status, intraoperative hemodynamic parameters, ventilatory complications, additional postoperative opioid requirements, Intensive Care Unit (ICU) stay, and total length of hospital stay. Correlations between blood loss, transfusion requirements, and hemodynamic variables were evaluated.

Results

The robotic cystectomy group experienced less intraoperative bleeding (mean of 410 ± 185 mL vs. 662.5 ± 210 mL; p = 0.002), but no significant reduction in transfusion requirements (95% CI not reported; p = 0.110) despite a strong correlation between bleeding volume and need for transfusion (r = 0.78; p < 0.001). Opioid consumption was significantly higher in the open cystectomy group (75.9% vs. 33.3%; p = 0.004). There was no significant difference in intraoperative hypotension, vasoactive drug use, ventilatory complications, in-hospital mortality, ICU stay, or total hospital stay (p > 0.05 for all). However, the small sample size limits the precision of these estimates.

Conclusion

While robot-assisted radical cystectomy was associated with reduced blood loss and lower additional postoperative opioid use, our small retrospective sample did not identify significant differences in intraoperative hemodynamic parameters or major complications. The surgical technique had no impact on in-hospital mortality.