Radical cystectomy with ileal conduit urinary diversion remains a standard surgical treatment for patients requiring urinary diversion (1),(2). The impact of surgical approach, including open, laparoscopic and robotic techniques, on perioperative outcomes, postoperative complications and quality of life (QoL) is not fully established. Minimally invasive approaches may reduce surgical morbidity and improve recovery. The aim of this study was to compare perioperative outcomes, postoperative complications and short term QoL following radical cystectomy with ileal conduit urinary diversion performed using different surgical approaches.

A multicenter retrospective study was conducted including 58 patients who underwent radical cystectomy with ileal conduit urinary diversion between March 2024 and March 2026. Patients were stratified according to surgical approach: open (n=18), laparoscopic (n=22) and robotic (n=18).
Evaluated parameters included operative time, length of hospital stay, perioperative hemoglobin variation, estimated glomerular filtration rate (eGFR), postoperative complications within 30 days and after 30 days, reintervention rates, pathological stage and use of adjuvant therapy.
Quality of life at 3 months postoperatively was assessed using the EQ-5D-5L questionnaire including mobility, self care, usual activities, pain or discomfort and anxiety or depression, as well as the EQ-VAS score (3).
Statistical analysis included ANOVA or Welch tests for normally distributed variables, Kruskal Wallis test with Dunn post hoc correction for non parametric variables and chi square or Fisher exact test for categorical data. A p value lower than 0.05 was considered statistically significant.

Operative time did not differ significantly between groups (p=0.187), although robotic procedures had a longer mean duration of 469 minutes. Length of hospital stay was significantly shorter in minimally invasive approaches: 13.5 days in the open group compared to 9 days in the laparoscopic group (p=0.008) and 7 days in the robotic group (p<0.001).
Postoperative hemoglobin levels were higher in the robotic group compared to the open group (10.76 versus 9.71 g/dL, p=0.042). Renal function showed different trends, with an increase in eGFR in the open group (p=0.002), a decrease in the laparoscopic group (p=0.021) and a non significant decrease in the robotic group, with significant differences between groups (p=0.001).
Non specific postoperative complications, including fistulas and eviscerations, were more frequent in the laparoscopic group (54.5 percent) compared to open and robotic approaches (both 5.6 percent, p<0.001). No significant differences were observed in major complications or reintervention rates.
Quality of life assessment using EQ-5D-5L showed no significant differences across most domains, except for improved self care in the laparoscopic group (p=0.028). EQ-VAS scores were higher in the robotic group compared to the open group (median 90 versus 72.5, p=0.016). Adjuvant therapy rates were similar across groups (22.4 percent, p=0.494). Findings are consistent with previously reported comparative analyses (2).

Minimally invasive approaches were associated with shorter hospitalization and improved perioperative hematologic outcomes, suggesting reduced surgical morbidity. However, the laparoscopic approach was associated with a higher rate of technical complications, which may be related to surgical technique and reconstruction factors. The robotic approach was associated with improved patient reported global health status.

Minimally invasive radical cystectomy with ileal conduit urinary diversion, particularly the robotic approach, is associated with improved postoperative recovery and higher patient reported health status without an increase in major complications. Laparoscopic surgery may be associated with higher technical complication rates. Appropriate patient selection and surgical expertise remain essential.

European Association of Urology. EAU Guidelines on Muscle Invasive and Metastatic Bladder Cancer. 2024.
Kowalewski KF, Wieland VLS, Kriegmair MC, et al. Robotic vs laparoscopic vs open radical cystectomy: network meta analysis of randomized controlled trials. Eur Urol Focus. 2023;9(3):480-490.
Bourke S, Bennett B, Oluboyede Y, et al. Minimally important difference for EQ-5D-5L and EORTC QLQ-C30 in cancer. Health Qual Life Outcomes. 2024;22:81.