Robot-assisted radical cystectomy and intracorporeal urinary diversion - safe and reproducible?
BACKGROUND
Robot-assisted radical cystectomy (RARC) plus intracorporeal urinary diversion is feasible. Few centers worldwide demonstrated comparable functional and oncologic outcomes. We reported a large series of RARC and intracorporeal diversion to assess its feasibility and reproducibility.


METHODS
We identified 101 RARCs in 82 men and 19 women (mean age 68.3 years) from October 2009 to October 2014. The patients underwent RARC and pelvic lymphadenectomy followed by intracorporeal urinary diversion (ileal conduit/ neobladder). Out of the 101 patients, 28 (27.7%) received intracorporeal ileal conduits and 73 (72.3%) intracorporeal neobladders. Studer pouch was performed in all the patients who underwent intracorporeal neobladder formation. Perioperative, functional and oncologic results including CSS and OS are reported.


RESULTS
Mean operative time was 402.3 minutes (205-690) and blood loss was 345.3 ml (50-1000). The mean hospital stay was 17.1 days (5-62). All the surgeries were completed with no open conversion. Minor complications (Grade I and II) were reported in 27.7% of patients while major complications (grade III and above) were reported in 36.6% of patients. The mean nodal yield was 20.6 (0-46). Positive ureteric margins were found in 8.9% of patients. The average follow-up was 27.5 months (1-52). Daytime continence could be achieved in 89.2% of patients who underwent intracorporeal neobladder. The 3-year cancer specific survival (CSS) and overall survival (OS) was 80.2% and 69.8% respectively.


CONCLUSIONS
RARC with intracorporeal diversion is safe and reproducible in 'non-pioneer' tertiary centers with robotic expertise having acceptable operative time and complications as well as comparable functional and oncologic outcomes.
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Allen
A
Sim
Department of Urology, Memorial Şişli Hospital, Istanbul, Turkey.
Mevlana Derya
MD
Balbay
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Tilman
T
Todenhöfer
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Stefan
S
Aufderklamm
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Omar
O
Halalsheh
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Johannes
J
Mischinger
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Johannes
J
Böttge
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Steffen
S
Rausch
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Simone
S
Bier
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Arnulf
A
Stenzl
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Georgios
G
Gakis
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Christian
C
Schwentner
Department of Urology, Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Ankara, Turkey.
Abdullah Erdem
AE
Canda
ileal conduit; intracorporeal diversion; neobladder; radical cystectomy; robot–assisted laparoscopy