title: Robot-assisted intracorporeal pyramid neobladder.
abstract: OBJECTIVE
  To describe a robot-assisted intracorporeal pyramid neobladder reconstruction technique and report operative and perioperative metrics, postoperative upper tract imaging, neobladder functional outcomes, and oncological outcomes.
  
  
  METHODS
  In all, 20 patients (19 male and one female) with a mean (sd; range) age of 57.2 (12.4; 31.0-78.2) years underwent robot-assisted radical cystectomy (RARC). Most cases were ≤pT1 (17 patients) and the remaining three patients had muscle-invasive bladder cancer (MIBC) at RARC histopathology. Although half of the patients (10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy, and intracorporeal neobladder formation using a pyramid detubularised folding pouch configuration.
  
  
  RESULTS
  The median estimated blood loss was 250 mL and operating time was 5.5 h. The mean (sd) number of lymph nodes removed was 16.5 (7.8) and median hospital stay was 10 days. Early postoperative complications included urinary tract infection (UTI) (four patients), ileus (four), diarrhoea and vomiting (three), postoperative collection (two), and blocked stent (one). Late postoperative complications included UTI (seven patients), neobladder stone (two), voiding Hem-o-Loc (two), neobladder leak (two), diarrhoea and vomiting (one), uretero-ileal stricture (one), vitamin B12 deficiency (one), and port-site hernia (one). There was no evidence of hydronephrosis in 18 patients with a median follow-up of 21.5 months. At 24 months, recurrence-free survival was 86% and overall survival was 100%. In all, 19 patients and 13 patients reported 6-month day time and night time continence, respectively.
  
  
  CONCLUSIONS
  The pyramid neobladder is technically feasible using a robotic platform and provides satisfactory functional outcomes at median of 21.5 months.
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Sridhar
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Miles
authors.initials: M
authors.lastname: Goldstraw
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hines
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cathcart
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Department of Urology and Division of Surgery and Interventional Science, University College London Hospital, London, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods
keywords: bladder cancer; cystectomy; intracorporeal; neobladder; robot-assisted; urinary diversion