title: Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles.
abstract: BACKGROUND
  Robotic radical cystectomy (RC) for cancer is beginning to gain wider acceptance. Yet, the concomitant urinary diversion is typically performed extracorporeally at most centers, primarily because intracorporeal diversion is perceived as technically complex and arduous. Previous reports on robotic, intracorporeal, orthotopic neobladder may not have fully replicated established open principles of reservoir configuration, leading to concerns about long-term functional outcomes.
  
  
  OBJECTIVE
  To illustrate step-by-step our technique for robotic, intracorporeal, orthotopic, ileal neobladder, urinary diversion with strict adherence to open surgical tenets.
  
  
  METHODS
  From July 2010 to May 2012, 24 patients underwent robotic intracorporeal neobladder at a single tertiary cancer center. This report presents data on patients with a minimum of 3-mo follow-up (n=8).
  
  
  METHODS
  We performed robotic RC, extended lymphadenectomy to the inferior mesenteric artery, and complete intracorporeal diversion. Our surgical technique is demonstrated in the accompanying video.
  
  
  METHODS
  Baseline demographics, pathology data, 90-d complications, and functional outcomes were assessed and compared with patients undergoing intracorporeal ileal conduit diversion (n=7).
  
  
  CONCLUSIONS
  Robotic intracorporeal urinary diversion was successfully performed in 15 patients (neobladder: 8 patients, ileal conduit: 7 patients) with a minimum 90-d follow-up. Median age and body mass index were 68 yr and 27 kg/m2, respectively. In the neobladder cohort, median estimated blood loss was 225 ml (range: 100-700 ml), median time to regular diet was 5 d (range: 4-10 d), median hospital stay was 8 d (range: 5-27 d), and 30- and 90-d complications were Clavien grade 1-2 (n=5 and 0), Clavien grade 3-5 (n=2 and 1), respectively. This study is limited by small sample size and short follow-up period.
  
  
  CONCLUSIONS
  An intracorporeal technique of robot-assisted orthotopic neobladder and ileal conduit is presented, wherein established open principles are diligently preserved. This step-wise approach is demonstrated to help shorten the learning curve of other surgeons contemplating robotic intracorporeal urinary diversion.
authors.affiliation: USC Institute of Urology, Hillard and Roclyn Center for Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Goh
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: de Castro Abreu
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Fairey
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Andre K
authors.initials: AK
authors.lastname: Berger
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
authors.forename: Karanvir S
authors.initials: KS
authors.lastname: Gill
authors.forename: Hui Wen
authors.initials: HW
authors.lastname: Xie
authors.forename: Leo Y
authors.initials: LY
authors.lastname: Chu
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D015653:Cystectomy; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects