Nerve‐sparing robot‐assisted radical cystoprostatectomy and urinary diversion

Abstract

through a 5-6 cm suprapubic incision. Second, a different surgical team exteriorized the bowel through this incision and created a neobladder extracorporeally. Third, the neobladder was internalized, the incision closed and the primary surgeon completed the urethro-neovesical anastomosis with robotic assistance. RESULTSRRCP was carried out in 14 men and three women by the primary surgeon (M.M.). The form of urinary reconstruction was ileal conduit in three, a W-pouch with a serosallined tunnel in 10, a double-chimney or a Tpouch with a serosal-lined tunnel in two each. The mean operative duration for robotic radical cystectomy, ileal conduit and orthotopic neobladder were 140, 120 and 168 min, respectively. The mean blood loss was <150 mL. The number of lymph nodes removed was 4-27, with one patient having N1 disease. The margins of resection were free of tumour in all patients. CONCLUSIONSWe developed a technique for nerve-sparing RRCP using the da Vinci system which allows precise and rapid removal of the bladder with minimal blood loss. The bowel segment can be exteriorized and the most complex form of orthotopic bladder can be created through the incision used to deliver the cystectomy specimen. Performing this part of the operation extracorporeally reduced the operative duration.

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

“…In total, 65 surgical series [4, and 22 comparative studies reported on pathologic, oncologic (n = 18), or functional (n = 9) outcomes of RARC.…”

“…Robot-assisted radical cystectomy (RARC) was initially described by Menon et al in 2003 [4]. Over time, many international centers have adopted RARC.…”

The Emergence of Surgeon-Controlled Robotic Surgery in Urologic Oncology

“…The main drawbacks of LRC, however, were again long learning curves for surgeons, morbidity and complications [18]. It was not until Menon et al performed a successful SCRRC that interest grew for robotic surgery among the urologic community [20]. Guru et al also performed SCRRC on twenty consecutive patients between 2005 and 2006 and concluded that the procedure can be performed safely for candidates for open cystectomy [21].…”

“…The patient is turned onto the table in a modified lateral decubitus [39]. Pneumoperitoneum is achieved with a Veress needle to a pressure of [15][16][17][18][19][20]. SCRRN is commenced by identifying and incising the white line of Toldt away from the bowel and the bowel is mobilized from the iliac vessels [39].…”

Robotic radical cystectomy for the management of bladder cancer: Analysis of operative and pathological outcomes of eighteen patient

“…[4] After accumulation of experience in laparoscopic surgery, the first robot-assisted radical cystectomy was described, and realized by Menon et al in the year 2003. [5] Thanks to its lesser morbidity with better oncological, and functional results robotic radical prostatectomy has been started to be used prevalently. Besides in line with accumulating experiences in robotic surgery, first publications were released about robotic radical cystectomy (RRC).…”