title: Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique.
abstract: BACKGROUND
  Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results.
  
  
  METHODS
  Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC) and neobladders (NB). SAS(®) Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05.
  
  
  RESULTS
  Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57). All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01) and orthotopic NB (13 vs. 7.5-day, P < 0.01) when comparing the first third of the cohort with the rest of the group. Overall median (range) operative time and estimated blood loss was 7 h (4.8-13) and 200 mL (50-1200), respectively. Within 30-day postoperatively, complications occurred in 61 (59%) patients, with the majority being low grade (n = 43), and no patient died. Median (range) nodes yield was 36 (0-106) and 4 (3.9%) specimens had positive surgical margins.
  
  
  CONCLUSIONS
  Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Andre Luis de Castro
authors.initials: AL
authors.lastname: Abreu
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Raed A
authors.initials: RA
authors.lastname: Azhar
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Andre K
authors.initials: AK
authors.lastname: Berger
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.affiliation: Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
keywords: Bladder cancer; intracorporeal urinary diversion; robot-assisted radical cystectomy; robotic; urinary diversion
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