Robot-assisted radical cystectomy with the clinical application of "Y-shaped" end-to-side ureteral anastomosis in elderly and obese patients

Abstract

Objective: To investigate the clinical effect and safety of "Y-shaped" end-to-side ureteral anastomosis with robotic endoscopic technique in radical cystectomy (RC) and urinary diversion (UD) in elderly and obese patients with bladder cancer. Materials and methods: We retrospectively reviewed the records of 10 patients with bladder cancer who underwent robot-assisted laparoscopic radical cystectomy and "Y-shaped" end-to-side ureteral anastomosis under general anesthesia at Zhejiang Provincial People's Hospital (Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China, 310014) from October 2018 to January 2021. Demographic and clinical data are summarized. The incidence of postoperative complications such as papillary retraction, ureteral stricture, anastomotic stenosis, anastomotic fistula and ureteral calculi were observed and analyzed. Results: A total of 10 elderly and obese patients successfully underwent RC with "Y-shaped" end-to-side ureteral anastomosis in this research. Median age was (80.6±5.7)y and BMI was (25.12±3.83) kg/m2. The operation time was (95±26) min and the estimated intraoperative blood loss was (100.5±35.6) ml, with no perioperative blood transfusion and no readmission 30 days after operation. No serious complications above Clavien-Dindo grade 4 occurred in the early (≤30 d) and late (> 30 d) after surgery. 1 patient developed fever 3 days after operation and was cured by strengthening anti-infection. 1 patient had a small amount of urine leakage at the anastomotic site after operation, and recovered after strengthening nutrition and maintaining the patency of abdominal drainage tube and single J tube. Postoperatively, the patients replaced the single J tube regularly and were followed up for 3-28 months (average 15 months) until April 10, 2021. In 2 cases, the ureterostomy nipple was slightly retracted and collapsed without special treatment. 1 case formed ureteral calculi and was treated conservatively. No ureteral stenosis, necrosis, anastomotic stenosis or severe anastomotic fistula, hernia around the stoma occurred. No visceral metastases or new lesions of urothelial carcinoma were observed. All patients were satisfied with the postoperative quality of life. Conclusions: The robot-assisted "Y-shaped" end-to-side ureteral anastomosis technique performed intracorporeally seems to be a straightforward, secure, and viable approach. It is considered suitable for radical resection of bladder cancer and urinary diversion in elderly and obese patients.