title: Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience.
abstract: BACKGROUND
  The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation.
  
  
  METHODS
  Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates.
  
  
  RESULTS
  The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women.
  
  
  CONCLUSIONS
  Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Collins
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden ; Department of Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sooriakumaran
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Ahonen
authors.affiliation: Department of Oncology and Pathology, Section of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Nyberg
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.
authors.forename: N P
authors.initials: NP
authors.lastname: Wiklund
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Hosseini
keywords: Neobladder; oncological outcomes; radical cystectomy; robot assisted radical cystectomy; robotic cystectomy; surgical technique; totally intracorporeal
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