Robot assisted radical cystectomy with Florence Robotic Intracorporeal Neobladder (FloRIN): Functional and urodynamic features compared with a contemporary series of open Vescica Ileale Padovana (VIP)

Maida, Fabrizio Di; Grosso, Antonio Andrea; Tasso, Giovanni; Lepri, Gemma; Lambertini, Luca; Nardoni, Samuele; Mari, Andrea; Tuccio, Agostino; Vittori, Gianni; Masieri, Lorenzo; Minervini, Andrea

doi:10.1016/j.ejso.2022.04.007

Cited by 7 publications

(22 citation statements)

References 23 publications

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“…The peri‐ and postoperative outcomes after (t)iRARC were similar to those recorded after (m)iRARC. In terms of postoperative complications, the reported overall complication rate of 57% and major complication rate of 10% are comparable to most contemporary iRARC series [15–17], confirming the safety of the ERUS curriculum. The trainee was able to obtain results similar to those of the mentor after 20 cases.…”

Section: Discussionsupporting

confidence: 71%

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

et al. 2023

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To provide the first clinical validation of the European Association of Urology Robotic Urology Section (ERUS) curriculum for training in robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). Patients and MethodsThe ERUS proposed a structured curriculum, divided into 11 steps, to train novice surgeons and help overcome the steep learning curve associated with iRARC. In this study, one trainee completed the curriculum under the mentorship of an expert. Twenty-one patients were operated on by the trainee following the proposed iRARC curriculum [(t)iRARC group] and were compared with 42 patients treated with the standard of care by the mentor [(m)iRARC group]. To evaluate curriculum safety, peri-operative outcomes, surgical margins and complications were assessed. Propensity-score matching (1:2) was used to identify comparable (t)iRARC and (m)iRARC cases. Matched variables included age, body mass index, neoadjuvant therapy, American Society of Anesthesiologists score and cT stage. Mann-Whitney and chi-squared tests were used to compare peri-and postoperative outcomes between the two cohorts. To evaluate curriculum efficacy, steps attempted and completed by the trainee were assessed and studied as a function of growing surgical experience of the trainee. ResultsThe trainee progressed in proficiency-based training through steps of increasing difficulty. No differences in estimated blood loss, positive soft tissue margins, number of resected lymph nodes, overall and high-grade complications, or 90-day readmissions between the (t)iRARC and (m)iRARC groups were observed (all P > 0.05). However, operating time was significantly longer in the (t)iRARC group (P = 0.01). Of the 209 available steps, the trainee attempted 168 (80%) and successfully performed 125 (60%). Increasing experience was associated with more steps being successfully performed (P < 0.001). ConclusionsThe proposed ERUS curriculum assists na€ ıve surgeons during the learning curve for iRARC and should be encouraged in order to guarantee optimal outcomes during the learning phase of this procedure.

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Section: Discussionsupporting

confidence: 71%

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

et al. 2023

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“…Data about OT were extracted from seventeen studies 13 – 17 , 25 – 27 , 29 – 31 , 33 , 34 , 37 , 39 – 41 , with high heterogeneity among studies (I 2 =97.2%), so we used random effect model. Our final meta-analysis indicated that ORC group was less than iRARC group in terms of OT (WMD: 68.54; 95% CI 47.41–89.67; P <0.001, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Among the sixteen studies on the EBL 13 – 17 , 25 – 27 , 30 , 31 , 33 , 34 , 37 , 39 – 41 , obvious heterogeneity was observed (I 2 =97.3%), so we applied the random effect model to statistical analysis. Our final outcomes revealed that iRARC had a less EBL than ORC (WMD: −555.52; 95% CI, −681.64 to −429.39; P <0.001, Fig.…”

Section: Resultsmentioning

confidence: 99%

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Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Fu,

Shi,

Fan

et al. 2024

International Journal of Surgery

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Background: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. Methods: The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. Results: Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: −555.52; 95% CI, −681.64 to −429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: −2.05; 95% CI, −2.93 to −1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades<III complication rate for iRARC were similar to that for ORC. Interestingly, the results of subgroup analysis revealed no difference in EBL between iRARC and ORC when the diversion type was neobladder. When the ileal conduit was selected as the diversion type, the LOS was similar in both procedures. Conclusion: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.

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“…The USC group reported an abdominal leak point pressure of 40–50 cm H 2 O as determined via provocative testing. Di Maida et al showed the superiority of ICNBs to open groups in terms of urgency domain, psychological status, and physical self-acceptance in FACT-BL and EORCT-QLQ-C30 [ 44 ]. Postoperative urodynamic assessment at 6 months showed significantly higher NB compliance in the ICNB group.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Cystectomy with Modified Vesica Ileale Padovana (VIP) Neobladder Configuration Using a Hybrid Approach: Initial Experience

Shimizu

Muto

Kitamura

et al. 2023

JPM

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Purpose: We developed a new technique to fold a neobladder (NB) simply by using a modified Vesica Ileale Padovana (VIP) with a hybrid approach. We provide a step-by-step description of our technique as it was used in this initial experience. Methods: A total of 10 male patients with a median age of 66 years underwent robot-assisted radical cystectomy (RARC) with an orthotopic NB via a hybrid approach from March 2022 to February 2023. After the isolation of the bladder and bilateral pelvic lymphadenectomy, Wallace plate creation was performed, and the robot was undocked. We extracorporeally performed the removal of the specimen and a side-to-side ileoileal anastomosis, and then the VIP NB posterior plate was rotated 90 degrees counterclockwise using a 45 cm detubularized ileum. The robot was redocked; then, circumferential urethra–ileal anastomosis, side-to-middle anterior wall closure, and ureteric afferent limb anastomosis were performed. Results: The median estimated blood loss was 524 mL, and the mean operative time was 496 min. Patients had a high continence rate, and no high-grade complications were observed. Conclusion: The NB configuration using the modified VIP method for a hybrid approach is a feasible surgical technique to minimize the movement of robotic forceps. In particular, it may be more useful in Asian individuals with narrow pelvises.

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Robot assisted radical cystectomy with Florence Robotic Intracorporeal Neobladder (FloRIN): Functional and urodynamic features compared with a contemporary series of open Vescica Ileale Padovana (VIP)

Cited by 7 publications

References 23 publications

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Robot-Assisted Radical Cystectomy with Modified Vesica Ileale Padovana (VIP) Neobladder Configuration Using a Hybrid Approach: Initial Experience

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