Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The karolinska experience

Abstract

Introduction:The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation.Materials and Methods:Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates.Results:The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women.Conclusions:Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer (part 2). Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder

“…We identified 40 studies in the literature that specifically addressed the use of totally ICONB in the treatment of bladder cancer. Among these, the most frequent type of UD described was the Studer “U” modified neobladder (twenty eight studies, 70%) [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ], followed by the Hautmann “W” modified neobladder (three studies, 7.5%) [ 13 , 44 , 45 ], the “Y" neobladder [ 46 , 47 ] and the Padua ICONB (two studies each, 5%) [ 48 , 49 ]. The Camey reservoir [ 50 ], the pyramid pouch [ 51 ], the robot-assisted vescica ileale padovana (ra-VIP) [ 52 ], and the Florence robotic intracorporeal neobladder (FloRIN) urinary diversion [ 53 ] were reported in only one study each.…”

“…(2014) [ 26 ], c 37 IC (51%) Studer “U” (49%) 75 f 62 f 84.0 72.0 386 f 387 f 92 f 124 f 250 f 200 f 10.0 0.0 16.0 f 12.0 f 42.0 67.0 27.0 6.0 47.0 67.0 32.0 17.0 NA NA NA Collins et al. (2014) [ 27 ], a 80 Studer “U” 64.0 e NA 420 f NA 475 f 4.0 31.0 e 17.0 27.0 11.0 19.0 87.0 80.0 69.0 Abreu et al. (2014) [ 28 ], c 103 IC (55%) Studer “U” (45%) 72 f 60.5 f 75.0 89.0 396 f 462 f NA 250 f 200 f 7.0 0.0 NA 42.0 41.0 23.0 21.0 NA NA NA NA NA Desai et al.…”

“…Collins et al. [ 27 ] in their report of 70 RARC with Studer “U” ICONB indicated that the most common early complications were urosepsis (8.6%), lymphocele (5.7%), abdominal abscess (4.3), uretero-ileal leakage (4.3%), paralytic ileus (2.9%), bleeding from major vessels (2.9%) and deep vein thrombosis/pulmonary embolism (2.8%). The predominant late complications were urinary tract infection (9.8%), obstructive uropathy (4.3%), uretero-ileal stricture (4.3%), and neobladder stones (2.8%).…”

The current status of robot-assisted cystectomy

“…(Early period (2008–2012) and late period (2012–2017)). [ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 ] All the included studies may overlap and may also include periods of surgeons’ learning curve. The fact that in the late period, we see more “mature” studies, does not result in significant improvements in the perioperative or oncological outcomes.…”

Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

“…Collins and colleagues [20] perform the urethro-neobladder anastomosis at the beginning of the procedure, immediately following identification, but prior to harvest of the ileal segment. This strategy ensures adequate ileal length and mesenteric mobility so that the surgeon may be sure to complete the urethro-neobladder anastomosis under the least tension possible.…”