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

Abstract

To review the most used intracorporeal orthotopic ileal neobladder (ICONB) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images. Methods We performed a non-systematic review of the literature with the keywords “bladder cancer”, “urinary diversion”, “radical cystectomy”, and “neobladder”. Results Forty studies were included in the analysis. The most frequent type of ICONB was the modified Studer “U” neobladder (70%) followed by the Hautmann “W” modified neobladder (7.5%), the “Y” neobladder (5%), and the Padua neobladder (5%). The operative time to perform a urinary diversion ranged from 124 to 553 min. The total estimated blood loss ranged from 200 to 900 mL. The rate of positive surgical margins ranged from 0% to 8.1%. Early minor and major complication rates ranged from 0% to 100% and from 0% to 33%, respectively. Late minor and major complication rates ranged from 0% to 70% and from 0% to 25%, respectively. Conclusion The most frequent types of ICONB are Studer “U” neobladder, Hautmann “W” neobladder, “Y” neobladder, and the Padua neobladder. Randomized studies comparing the performance of the different types of ICONB, the performance in an intra or extracorporeal manner, or the performance of an ICONB versus ICIC are lacking in the literature. To this day, there are not sufficient quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images of each technique.

Robot-Assisted Radical Cystectomy with Intra-Corporeal Neo-Bladder

“…The medial and ventral surfaces of the Seminal vesicle is transect, preserving the middle part and tip avoiding parasympathetic fibers damage in selected cases. The prostate vesicular angle is follow laterally to the apex [20][21][22][23] (Figure 9).…”

“…The neobladder creation goes by selecting a 40 cm ileal segment form 15 to 20 cm proximal to the ileocecal valve. The segment is arranged in a modified Y shape [22]. The ileal segment is approximate to the urethra for an anastomosis (Figure 12).…”

“…The proximal part of the posterior plate is folded anteriorly and suture for the creation of the anterior wall, the lateral windows are closed with running sutures (Figure 15) [22,23].…”

“…The neobladder is tested by the instillation of 500 cc of saline by the definitive catheter. A drain is place in the left side of the cavity and the specimen is extracted at the end of the procedure via a 5 cm midline incision [22,23]. Robot-Assisted Radical Cystectomy with Intra-corporeal Neo-Bladder DOI: http://dx.doi.org/10.5772/intechopen.98973…”

“…The rest of the segment is part of the chimney and in his lower side proximal to the pouch is kept open to stend the ureters later. The uretero-ileal anastomosis is perform in the free-top of the chimney once the Simple J ureteric stents were previously introduce [22,23].…”