Background: To report the surgical techniques and results of robot-assisted radical cystectomy (RARC) with intracorporeal Mainz Ⅱ rectosigmoid pouch at our centre. Methods: Two female patients were treated with this procedure. Construction of the pouch was divided into four main steps: incision of the rectum and sigmoid colon, closure of the posterior wall of the pouch, reimplantation of the ureters at the bottom of pouch in an anti-reflux manner, and closure of the anterior wall. Surgical results and perioperative complications were assessed.
Results:The operations were performed completely intracorporeally. No perioperative complications were observed. Postoperatively, high-grade invasive urothelial carcinoma was detected. On postoperative day 60, no bilateral ureteral dilation was detected. Two patients demonstrated total continence. Clinical recurrence was not observed during the follow-up period.Conclusions: With careful patient selection, robot-assisted intracorporeal Mainz Ⅱ rectosigmoid pouch might be a simple minimally invasive surgical technique to be evaluated in repeated applications.
K E Y W O R D Sbladder cancer, continent urinary diversion, Mainz Ⅱ rectosigmoid pouch, robot-assisted radical cystectomy
| INTRODUCTIONWorldwide, bladder cancer is the second most common cancer of the urinary tract and is associated with high morbidity and mortality. Urothelial carcinoma accounts for nearly 90% of all primary bladder tumours. 1,2 Radical cystectomy (RC) is now considered the gold standard for the treatment of muscle-invasive urothelial bladder cancer or high-grade, recurrent non-muscleinvasive bladder tumours. [2][3][4] However, both open radical cystectomy and laparoscopic radical cystectomy with continent or incontinent urinary diversion are standard procedures associated with a risk for severe complications. Conversely, robot-assisted radical cystectomy (RARC) has been reported to reduce morbidity and mortality after RC. Due to inexperience with intracorporeal urinary diversion, most surgeons have performed RARC with extracorporeal urinary diversion. 4 As the technology develops, urinary diversion should be performed intracorporeally along with RC.