title: Robot-Assisted Radical Cystectomy with Total Intracorporeal Urinary Diversion: Comparative Analysis with Extracorporeal Urinary Diversion.
abstract: OBJECTIVE
  To compare the perioperative outcomes, postoperative complications, and early oncologic outcomes of intracorporeal urinary diversion (ICUD) with those of extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) performed by a single surgeon at a tertiary referral hospital.
  
  
  METHODS
  We reviewed a prospectively maintained, institutional review board-approved database of 70 patients treated with RARC and pelvic lymph node (LN) dissection for bladder cancer performed from 2007 through 2014. Data were collected for 64 patients who underwent either ICUD or ECUD.
  
  
  RESULTS
  Thirty-eight patients underwent ECUD, and the remaining 26 underwent ICUD. Urinary diversion was performed extracorporeally in the first 37 cases and performed intracorporeally thereafter. There were no significant differences in patient characteristics between the ECUD and ICUD groups. Mean total operative time was 468 minutes for ECUD and 581 minutes for ICUD (P < .05). Mean estimated blood loss was 265 and 148 mL, respectively (P < .05). Minor and total complication rates for patients with the ECUD were higher than in patients with the ICUD (minor: 47.4% vs. 15.4%; total: 57.9% vs. 30.8%; P < .05). All patients showed negative surgical margin, while 21% in the ECUD group and 26.9% in the ICUD group had pathologic stage T3 or T4 (P > .05). The mean LN yield was 23.2 and 31.8, respectively (P < .05).
  
  
  CONCLUSIONS
  From our experience, the results show that ICUD after RARC can be successful, with the benefits of decreased blood loss and lower transfusion and complication rates than ECUD. A larger series and long-term follow-up data will be necessary to support our results.
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Pyun
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Cho
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Sung Gu
authors.initials: SG
authors.lastname: Kang
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jeong Gu
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Je Jong
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*