Robot-Assisted Female Organ Sparing Cystectomy

The current EAU guidelines recommend offering organ-preserving radical cystectomy in women motivated to preserve their sexual function. In this chapter, we discuss our method of patient selection, preparation and positioning, and robotic female organ-preserving cystectomy technique, with a discussion and review of the literature on the outcomes of organ-preserving female cystectomy. Sexually active females with ≤ pT2, N0, M0 urothelial cancer, assessed via examination, imaging and pathological staging, are ideal candidates for organ-preserving cystectomy. Principles of enhanced recovery after surgery (ERAS) are applied in the perioperative period. We describe a step-by-step technique of pelvic organ preserving radical cystectomy. We review the literature on this technique with its oncological and functional outcomes. Robotic radical cystectomy with pelvic organ preservation is an oncologically safe, functionally beneficial, and reproducible technique. Prospective, multi-institutional studies with a larger cohort are the next step in making it more accessible for women undergoing radical cystectomy.