To introduce a novel robotic-assisted radical cystectomy (RARC) approach for bladder cancer patients, namely the combined posterior and lateral approach-and evaluate its efficacy.

A retrospective analysis was conducted on clinical data from 21 bladder cancer patients aged 47-80 years who underwent RARC. Among them, 12 underwent the combined posterior and lateral approach, while 9 underwent the traditional lateral approach. Clinical characteristics were compared between the two groups. The key step of the combined approach involved first incising the peritoneal reflection of the bladder prior to the lateral approach to release pelvic adhesions, mobilize the posterior bladder wall, expose the lateral bladder ligaments, and gradually expose the bilateral seminal vesicles and posterior wall of the prostate along Denonvilliers’ fascia, followed by ligation of the bilateral vas deferens arteries.

All 21 patients successfully completed the surgery. Compared to the traditional lateral approach group, the combined approach group demonstrated significantly shorter ureterostomy time [295.0 (275.0, 300.0) vs 445.0 (354.5, 501.6), P=0.034] and ileal neobladder reconstruction time [330.0 (320.0, 414.0) vs 490.0 (396.0, 545.5), P=0.019]. There were no statistically significant differences between the two groups in postoperative hospital stay, postoperative creatinine levels, or postoperative complication rates (P>0.05).

The combined posterior and lateral approach for RARC offers advantages in reducing operative time and improving intraoperative exposure, making it a safe and efficient surgical technique for RARC.