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Miller School Investigators Compare Recovery from Open Versus Robotic Bladder Removal Surgery

Patients undergoing bladder removal surgery, known as cystectomy, need from three to six months to recover regardless of whether they have robot-assisted radical cystectomy or the traditional open approach, according to a multicenter study led by Miller School investigators and published in JAMA Network Open.

Dipen J. Parekh, M.D.

“To our knowledge this is the first study on time to recovery following open versus robotic cystectomy. These outcomes will be invaluable to urologists counseling and preparing these patients for surgery,” said the study’s lead author Dipen J. Parekh, M.D., professor and chair at the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine and director of robotic surgery.

The Miller School was among 15 U.S. academic center urology departments to participate in the National Cancer Institute funded Randomized Open versus Robotic Cystectomy (RAZOR) trial, published in 2018 in The Lancet. In this study, authors used data from the RAZOR trial to analyze the functional recoveries of 150 patients who had robot-assisted radical cystectomy versus 152 who had open radical cystectomy.

The investigators compared how quickly patients resumed pre-surgery activities of daily living, including grooming and toileting; independent activities of daily living, which includes more complex self-care such as meal preparation; hand grip strength; and Timed Up and Go Walking Test.

By three months, patients in both groups recovered activities of daily living, independent activities of daily living and the walking test, which involves timing patients as they stand from a chair, walk three meters, turn, walk back and sit again. Hand grip strength, a commonly used measure of independence, was back to baseline in both groups by six months.

“There was no significant difference in these functional measures between robotic and open cystectomy at any point,” said Dr. Parekh, who also is the Victor A. Politano Endowed Chair in Urology at the Miller School.

There were slight differences in early functional recoveries between the surgical approaches. For example, robotic patients recovered activities of daily living and hand grip strength at one month after their procedures, versus three months for patients having open radical cystectomy.

“While more studies need to be done to help set realistic expectations prior to radical cystectomy, the percentage of patients recovering in each group in our study was similar at each time point. And any differences we detected in early recoveries did not impact complications at 90 days or risk of death at one year,” said Vivek Venkatramani, M.S., M.Ch, urologic oncology and robotic surgery fellow and co-author of the study.

Other Miller School study authors were: Isildinha M. Reis, Ph.D., research professor in biostatistics in the Department of Public Health Science; and Mark L. Gonzalgo, M.D., Ph.D, professor of urology.

Written by Lisette Hilton
Published on February 16, 2022