title: Feasibility of robot-assisted totally intracorporeal laparoscopic ileal conduit urinary diversion: initial results of a single institutional pilot study.
abstract: OBJECTIVE
  To explore the use of the da Vinci Surgical Robotic System (DSRS) to assist in the completion of totally intracorporeal laparoscopic ileal conduit urinary diversion (TLIC).
  
  
  METHODS
  Two patients with radiation cystitis underwent TLIC procedures and another patient with bladder cancer underwent TLIC along with laparoscopic radical cystoprostatectomy at our institution. The ileal conduit urinary diversion was done totally intracorporeally using conventional laparoscopic techniques, and the DSRS was used to assist in the Bricker-type ureteroileal anastomosis.
  
  
  RESULTS
  The 3 patients in the study included 2 men and 1 woman (mean age 73 years, range 64 to 84). The TLIC was completed intracorporeally in all 3 patients without the need for open conversion. The operative time, estimated blood loss, intraoperative decrease in hemoglobin, and time to hospital discharge for the 2 patients undergoing TLIC and the patient undergoing TLIC along with radical cystoprostatectomy was 628, 616, and 828 minutes, 50, 200, and 500 mL, 1.7, 2.8, and 5.3 g, and 5, 7, and 10 days, respectively. The median follow-up was 4.5 months (range 3.5 to 5.5). Postoperative satisfactory drainage of both kidneys was confirmed in all 3 patients at 8 weeks or later by intravenous urography or renal nuclear imaging. The serum creatinine remained stable in all 3 patients after surgery at hospital discharge. The only complication noted was postoperative ileus in the patient undergoing radical cystoprostatectomy that resolved with conservative management.
  
  
  CONCLUSIONS
  TLIC is technically feasible and safe and can be done intracorporeally without complications. The DSRS can be successfully used to assist in the completion of TLIC. However, that each case lasted for more than 600 minutes highlights the need for further refinement in the technique. The practical application of TLIC requires improved long-term outcomes compared with open surgery, as well as a reduction in the operative time to justify the costs of robotic surgery.
authors.affiliation: Division of Urologic, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-2360, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Balaji
authors.forename: Paulos
authors.initials: P
authors.lastname: Yohannes
authors.forename: Corrigan L
authors.initials: CL
authors.lastname: McBride
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
authors.forename: George P
authors.initials: GP
authors.lastname: Hemstreet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D003556:Cystitis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods; D011832:Radiation Injuries / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation*; D012449:Safety; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation* / Q000379:methods