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Surgery in Motion

Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

By: Giuseppe Simonea , Rocco Papaliab , Leonardo Misuracaa, Gabriele Tudertia, Francesco Minisolaa, Mariaconsiglia Ferrieroa, Giulio Vallatic, Salvatore Guaglianonea and Michele Galluccia

European Urology, November 2016

Published online: 26 November 2016

Keywords: Bladder cancer, Intracorporeal urinary diversion, Orthotopic neobladder, Padua ileal bladder, Radical cystectomy, Robotic intracorporeal neobladder, Robotic surgery

Abstract Full Text Full Text PDF (890 KB)

Abstract

Background

Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility.

Objective

To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder.

Design, setting, and participants

From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre.

Surgical procedure

RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video.

Measurements

Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported.

Results and limitations

Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305 min (interquartile range [IQR]: 282–345). Median estimated blood loss was 210 ml (IQR: 50–250). Median hospital stay was 9 d (IQR: 7–12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results.

Conclusions

Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience.

Patient summary

We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres.

Take Home Message

Our experience supports the feasibility of totally-intracorporeal neobladder following robotic radical cystectomy. Robotic intracorporeal Padua ileal bladder is a safe surgical option in tertiary referral centres. Operative times and perioperative complication rates are likely to be reduced with increasing experience.

Keywords: Bladder cancer, Intracorporeal urinary diversion, Orthotopic neobladder, Padua ileal bladder, Radical cystectomy, Robotic intracorporeal neobladder, Robotic surgery.

Footnotes

a Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy

b Department of Urology, Campus Biomedico University, Rome, Italy

c Department of Radiology, “Regina Elena” National Cancer Institute, Rome, Italy

Corresponding author. Department of Urology, “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, Rome 00144, Italy. Tel. +39 3924689214.

These authors contributed equally.

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