title: Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder.
abstract: BACKGROUND
  Robot-assisted radical cystectomy (RARC) may reduce morbidity after cystectomy. Descriptions of the surgical techniques of RARC with intracorporeal orthotopic neobladder or ileal conduit are sparse and oncologic and functional outcome data have not been reported.
  
  
  OBJECTIVE
  We present our technique with RARC and intracorporeal urinary diversion (neobladder or ileal conduit) and present oncologic and functional outcomes, as well as complication rates.
  
  
  METHODS
  Single-hospital institution case-series from 2004 to 2009 including 45 selected patients (38 male, 7 female) with high-grade and/or muscle-invasive urothelial cancer of the bladder.
  
  
  METHODS
  We performed RARC; pelvic lymph node dissection using three different templates; and a totally intracorporeal urinary diversion, either orthotopic neobladder (n=36) or ileal conduit (n=9).
  
  
  METHODS
  Perioperative variables, pathology data, early and late complication rates, urinary continence, potency, and cancer-specific survival were evaluated as outcome measures.
  
  
  CONCLUSIONS
  Median patient age, operative time, estimated blood loss, and lymph node yield were 62 yr (range: 37-79), 477 min (range: 325-760), 550 ml (range: 200-2200), and 19 (range: 10-52), respectively. Nine patients were diagnosed with positive lymph nodes. Surgical margins were clear in all but one patient. Early complications occurred in 18 patients (40%). Median postoperative stay was 9 d (range: 4-78), and median postoperative follow-up time was 25 mo. Four patients died due to metastatic disease. The study is limited by a relative small sample size and no comparative group.
  
  
  CONCLUSIONS
  RARC with totally intracorporeal urinary diversion is technically feasible with good intermediate-term oncologic results. This is a nonrandomised study including a limited number of patients with a restricted follow-up time, however, and so precautions must be considered when interpreting the outcomes.
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden. martin.n.jonsson@karolinska.se
authors.forename: Martin N
authors.initials: MN
authors.lastname: Jonsson
authors.forename: L Christofer
authors.initials: LC
authors.lastname: Adding
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.forename: Martin C
authors.initials: MC
authors.lastname: Schumacher
authors.forename: Daniela
authors.initials: D
authors.lastname: Volz
authors.forename: Andreas
authors.initials: A
authors.lastname: Nilsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: N Peter
authors.initials: NP
authors.lastname: Wiklund
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002983:Clinical Competence; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D015996:Survival Rate; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects