title: Robotic radical cystectomy with intracorporeal neobladder: Initial experience and outcomes.
abstract: BACKGROUND
  Total intra-corporeal robot-assisted radical cystectomy (RARC) with total intracorporeal neobladder formation is relatively new in the treatment of bladder cancer. We present our experience and believe it is the first Canadian reported series with this technique.
  
  
  METHODS
  This is a case series of 4 patients, who underwent total RARC, pelvic lymphadenectomy and creation of an intra-corporeal ileal neobladder. Surgical technique is described and perioperative variables, pathologic data, and complication rates are reported.
  
  
  RESULTS
  The mean patient age was 61.8 and the mean body mass index was 27.01 kg/m(2). The mean operative time, estimated blood loss, time to full diet and length of stay were 522.8 minutes (standard deviation [SD] 74.5), 237.5 mL (SD 47.9), 9 days (range: 3-24) and 12.8 days (range: 6-31), respectively. All patients completed postoperative functional evaluation showing a mean neobladder capacity of 575 cc (range: 500-720). Surgical margins and pathological nodal status were negative in all patients with no evidence of disease recurrence or progression on follow-up. Three of the 4 patients suffered a complication within 90 days, with one occurring later in the first year. All early complications were Clavien grade I-II (grade I [n = 1]; grade II [n = 2]) and the later complication was grade IIIa. The mean follow-up was 632 days (range: 562-730). The limitation of our study is its small sample size with highly selected patients to compensate for the learning experience. The follow-up is short; however, the outcomes are comparable to early experiences reported at other institutions.
  
  
  CONCLUSIONS
  In our initial experience, RARC with total intracorporeal neobladder formation is safe. We expect that with experience the expense of robotic surgery can be compensated with early ambulation and shorter stay.
authors.affiliation: Queen Elizabeth II Hospital, Grande Prairie, AB;
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Butt
authors.affiliation: Alberta Urology Institute, Edmonton, AB.
authors.forename: Ellen
authors.initials: E
authors.lastname: Forbes
authors.affiliation: Alberta Urology Institute, Edmonton, AB.
authors.forename: Jeff
authors.initials: J
authors.lastname: Zorn
authors.affiliation: Alberta Urology Institute, Edmonton, AB.
authors.forename: Blair St
authors.initials: BS
authors.lastname: Martin
references.citation: BJU Int. 2014 Sep;114(3):326-33
references.pmid: 24224480
references.citation: J Urol. 2007 Feb;177(2):437-43
references.pmid: 17222605
references.citation: Arch Esp Urol. 1993 Sep;46(7):621-4
references.pmid: 8239740
references.citation: Eur Urol. 2003 Sep;44(3):337-9
references.pmid: 12932932
references.citation: Eur Urol. 2010 Feb;57(2):196-201
references.pmid: 19853987
references.citation: Eur Urol. 2012 Feb;61(2):350-5
references.pmid: 22036642
references.citation: J Urol. 2001 Jun;165(6 Pt 1):1863-6
references.pmid: 11371868
references.citation: Eur Urol. 2013 Nov;64(5):734-41
references.pmid: 23768634
references.citation: J Urol. 1992 Oct;148(4):1140-4
references.pmid: 1404624
references.citation: Eur Urol. 2012 Nov;62(5):891-901
references.pmid: 22920581
references.citation: BJU Int. 2012 Aug;110(3):434-44
references.pmid: 22177416