Eliminating the routine use of postoperative drain placement in patients undergoing robotic-assisted radical cystectomy with intracorporeal urinary diversion

• Published in: Urologic oncology 2023-11, Vol.41 (11), p.457.e1-457.e7
• Main Authors: Rich, Jordan M., Geduldig, Jack, Cumarasamy, Shivaram, Ranti, Daniel, Mehrazin, Reza, Wiklund, Peter, Sfakianos, John P., Attalla, Kyrollis
• Format: Article
• Language: English
• Subjects: Bladder cancer; Complication; Cystectomy - methods; drain; Female; Humans; Male; Medicin och hälsovetenskap; Operative Time; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Radical cystectomy; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Treatment Outcome; Urinary Bladder Neoplasms - complications; Urinary Diversion - methods; Urinary leak
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2023.08.015

•Patients in this study underwent robotic radical cystectomy (RC) for bladder cancer.•Largest drainless robotic RC with intracorporeal diversion series.•Low rates of complications, urine leaks, and infectious abdominal collections.•Prior radiation associated with urine leak and infectious abdominal collections.•Robotic RC can be safely done without routine postoperative drains. Perioperative management of patients undergoing radical cystectomy and urinary diversion utilizing both open and minimally invasive techniques have routinely included the use of drains in the operative field. We herein demonstrate the safety of robotic-assisted radical cystectomy (RARC) without the routine use of postoperative drains. Patients who underwent drainless RARC with intracorporeal urinary diversion between 2017 and 2022 at our institution were reviewed. Baseline and clinical characteristics as well as perioperative and postoperative outcomes were analyzed. The primary study outcome was incidence of postoperative urinary leak or intra-abdominal infectious collections within 90 days of RARC. A univariate and multivariable logistic regression analysis was performed to determine associations between study variables and the primary outcome. Of 381 patients, 298 (78.2%) were male and median age and BMI were 68 (63, 76) and 26.2 [23.0, 29.8], respectively. Overall 30 and 90-day complication rates were 39.6% and 50.4%, respectively. Twenty-one (5.5%) patients experienced a urine leak or intra-abdominal infectious collections. Sub-group analysis of patients who experienced the primary outcome demonstrated median postoperative day of presentation was day 19, and this group required 16 total additional procedures. On multivariable logistic regression analysis, only prior radiation therapy was associated with the development of the primary outcome of urinary leak or intra-abdominal infectious collection (odds ratio: 15.12, 95% confidence interval [1.52–156.8], p = 0.02). Drainless RARC with totally intracorporeal urinary diversion achieved competitive perioperative and complications outcomes compared to prior open and robotic series. In the context of a larger enhanced recovery after surgery protocol in RARC patients, the routine use of drains may be safely omitted.