title: Robot-assisted radical cystectomy and intracorporeal neobladder formation: on the way to a standardized procedure.
abstract: BACKGROUND
  Robot-assisted radical cystectomy (RARC) with intracorporeal diversion has been shown to be feasible in a few centers of excellence worldwide, with promising functional and oncologic outcomes. However, it remains unknown whether the complexity of the procedure allows its duplication in other non-pioneer centers. We attempt to address this issue by presenting our cumulative experience with RARC and intracorporeal neobladder formation.
  
  
  METHODS
  We retrospectively identified 62 RARCs in 50 men and 12 women (mean age 63.6 years) in two tertiary centers. Intracorporeal Studer neobladders were created, duplicating the steps of standard open surgery. Perioperative and postoperative variables and complications were analyzed using standardized tools. Functional and oncological results were assessed.
  
  
  RESULTS
  The mean operative time was 476.9 min (range, 310 to 690) and blood loss was 385 ml (200 to 800). The mean hospital stay was 16.7 (12 to 62) days with no open conversion. Perioperative complications were grade II in 15, grade III in 11, and grade IV in 5 patients. The mean nodal yield was 22.9 (8 to 46). Positive margins were found in in 6.4%. The 90- and 180-day mortality rates were 0% and 3.3%. The average follow-up was 37.3 months (3 to 52). Continence was achieved in 88% of patients. The cancer-specific survival rate and overall survival rate were 84% and 71%, respectively.
  
  
  CONCLUSIONS
  A RARC with intracorporeal neobladder creation is safe and reproducible in 'non-pioneer' tertiary centers with robotic expertise with acceptable operative time and complications. Further standardization of RARC with intracorporeal diversion is a prerequisite for its widespread use.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Allen
authors.initials: A
authors.lastname: Sim
authors.forename: Mevlana Derya
authors.initials: MD
authors.lastname: Balbay
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.forename: Stefan
authors.initials: S
authors.lastname: Aufderklamm
authors.forename: Omar
authors.initials: O
authors.lastname: Halalsheh
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.forename: Johannes
authors.initials: J
authors.lastname: Böttge
authors.forename: Steffen
authors.initials: S
authors.lastname: Rausch
authors.forename: Simone
authors.initials: S
authors.lastname: Bier
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, Ankara Atatürk Training & Research Hospital, Ankara, Turkey. erdcand@yahoo.com.tr.
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000592:standards; D001743:Urinary Bladder / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods*