Stapled vs Manually Sutured Bowel Anastomosis in Robot-Assisted Radical Cystectomy: a single-center retrospective analysis

Background: Radical cystectomy is the primary treatment for muscle-invasive bladder cancer and certain cases of high-risk non-muscle-invasive disease. Robot-assisted cystectomy techniques (RARC) have emerged as a minimally invasive alternative to traditional open surgery, offering enhanced precision. The creation of an effective bowel anastomosis is critical in these procedures, with manually sutured anastomosis being a good and significantly cheaper alternative to the standard stapled anastomosis. Methods: We conducted a retrospective study of 92 patients who underwent RARC between March 2021 and November 2023. Bowel anastomosis was performed using either stapled or manually sutured techniques. Outcome parameters included bowel-related complications, operation duration, length of hospital stay, intensive care unit (ICU) stay, readmissions, and postoperative recovery metrics. Results: Of the patients, 59 received manually sutured bowel anastomosis, while 33 received stapled anastomosis. Demographic analysis showed no significant differences between the groups. Gastrointestinal (GI) complications occurred in 25% of patients, predominantly paralytic ileus. There were no statistically significant differences in complication rates between the two techniques. Readmissions were higher in the sutured group, mainly due to non-GI complications. Operation duration and length of stay were similar in both groups. Conclusion: This study found comparable outcomes between stapled and manually sutured bowel anastomosis in RARC, with no significant increase in GI complications or in operation duration in manually sutured anastomosis. Considering the substantial financial advantage in favor of manual suturing, this technique could become the new standard.