Robotic radical cystectomy with totally intracorporeal urinary diversion: preliminary results
INTRODUCTION AND OBJECTIVES: In the last few years robotic radical cystectomy (RRC) for muscle invasive bladder cancer began to gain popularity. However total intracorporeal diversion is a challenging procedure. In this series we presented feasibility, complication rate and perioperative outcome of our first 58 patients treated with RRC and intracorporeal urinary diversion.
METHODS: From August 2012 to February 2014, 58 consecutive unselected patients with cT2-4a/cN0-3/cM0 bladder cancer underwent RRC, extended lymphadenectomy and totally intracorporeal diversion. Baseline demographics and perioperative
data were collected and reported.
RESULTS: Robotic intracorporeal urinary diversion was successfully performed in all patients (Padua Ileal Blabber: 48 patients, Ileal Conduit: 10 patients). Eight patients received neoadjuvant chemotherapy.
Demographic, perioperative and pathologic data are summarized into Table 1, Table 2 and Table 3, respectively.
Perioperative Clavien 3-5 grade complication rate was 20.7% (n=12/58) and occurred in patients receiving ON.
Complications included bowel anastomosis dehiscence and urinary leakage that were treated with re-anastomosis and bilateral nephrostomies, respectively.
CONCLUSIONS: RRC with totally intracorporeal urinary diversion is feasible and safe. The orthotopic reconstruction is
subject to a higher rate of 3-5 grade complications than IC even if it mostly happened in the first cases. A step-wise standardization of technique may reduce operative time and perioperative complication rate.