title: Robotic intracorporeal urinary diversion: technical details to improve time efficiency.
abstract: OBJECTIVE
  To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve.
  
  
  METHODS
  Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded.
  
  
  RESULTS
  All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250 mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow-up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively.
  
  
  CONCLUSIONS
  Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California , Los Angeles, California.
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Andre Luis Castro
authors.initials: AL
authors.lastname: de Abreu
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Goh
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Andre
authors.initials: A
authors.lastname: Berger
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Hui Wen
authors.initials: HW
authors.lastname: Xie
authors.forename: Karanvir S
authors.initials: KS
authors.lastname: Gill
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Sotelo
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.forename: Zhang
authors.initials: Z
authors.lastname: Xu
authors.forename: Inderbir Singh
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D061646:Operative Time; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*