Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique

• Published in: Indian journal of urology 2014-07, Vol.30 (3), p.300-306
• Main Authors: Abreu, Andre, Chopra, Sameer, Azhar, Raed, Berger, Andre, Miranda, Gus, Cai, Jie, Gill, Inderbir, Aron, Monish, Desai, Mihir
• Format: Article
• Language: English
• Subjects: Analysis; Bladder cancer; Care and treatment; Cystectomy; Health aspects; Innovations; intracorporeal urinary diversion; Methods; robot-assisted radical cystectomy; robotic; Robotic surgery; Symposium; urinary diversion
• ISSN: 0970-1591; 1998-3824
• DOI: 10.4103/0970-1591.135673

Introduction: Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results. Materials and Methods: Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC) and neobladders (NB). SAS ® Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05. Results: Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57). All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01) and orthotopic NB (13 vs. 7.5-day, P < 0.01) when comparing the first third of the cohort with the rest of the group. Overall median (range) operative time and estimated blood loss was 7 h (4.8-13) and 200 mL (50-1200), respectively. Within 30-day postoperatively, complications occurred in 61 (59%) patients, with the majority being low grade (n = 43), and no patient died. Median (range) nodes yield was 36 (0-106) and 4 (3.9%) specimens had positive surgical margins. Conclusions: Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.