title: Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients.
abstract: OBJECTIVE
  We present a 2-institution experience with completely intracorporeal robotic orthotopic ileal neobladder after radical cystectomy in 132 patients.
  
  
  METHODS
  Established open surgical techniques were duplicated robotically with all neobladders suture constructed intracorporeally in a globular configuration. Nerve sparing was performed in 56% of males. Lymphadenectomy was extended (up to aortic bifurcation in 51, 44%) and superextended (up to the inferior mesenteric artery in 20, 17%). Ureteroileal anastomoses were Wallace-type (86, 65%) or Bricker-type (46, 35%). The learning curve at each institution was assessed using chronological subgroups and by trends across the entire cohort. Data were prospectively collected and retrospectively queried.
  
  
  RESULTS
  Mean operating time was 7.6 hours (range 4.4 to 13), blood loss was 430 cc (range 50 to 2,200) and hospital stay was 11 days (median 8, range 3 to 78). Clavien grade I, II, III, IV and V complications within 30 days were 7%, 25%, 13%, 2% and 0%, respectively, and between 30 and 90 days were 5%, 9%, 11%, 1% and 2%, respectively. Mean nodal yield was 29 (range 7 to 164) and the node positivity rate was 17%. Operative time, blood loss, hospital stay and prevalence of late complications improved with experience. During a mean followup of 2.1 years (range 0.1 to 9.8) cancer recurred in 20 patients (15%). Five-year overall, cancer specific and recurrence-free survival was 72%, 72% and 71%, respectively.
  
  
  CONCLUSIONS
  We developed a refined technique of robotic intracorporeal orthotopic neobladder diversion, duplicating open principles. Operative efficiency and outcomes improved with experience. Going forward, we propose a prospective randomized comparison between open and robotic intracorporeal neobladder surgery.
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden. Electronic address: mihir.desai@usc.edu.
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: de Castro Abreu
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Christofer
authors.initials: C
authors.lastname: Adding
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Oscar
authors.initials: O
authors.lastname: Laurin
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Justin
authors.initials: J
authors.lastname: Collins
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Goh
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
mesh_terms: D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D065287:Robotic Surgical Procedures; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
keywords: cystectomy; robotics; urinary bladder neoplasms; urinary diversion