title: Simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy: technique description, outcomes, and literature summary.
abstract: The objectives of this study are to describe the surgical technique for simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy, to report its surgical bench marks, and finally, to summarize the current evidence on the procedure. After written informed consent, we prospectively enrolled consecutive patients undergoing simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy in a prospective institutional database. We performed all procedures with robotic assistance from the DaVinci Si-HD®, a four-arm robotic system. Endpoints included surgery duration, estimated intra-operative blood loss, resection margins, intra-, and post-operative complications. Furthermore, we describe oncological outcome at follow-up. We conducted six (54.4 %) right-sided and five (45.5 %) left-sided nephro-ureterectomies. Urinary diversion consisted in nine (81.2 %) ureterocutaneostomies and in two (18.8 %) ileum conduits. The median surgery duration was 287 min [interquartile range (Q1-Q3) 253-328], thereof 196-min console time (Q1-Q3 158-230). The median-estimated blood loss was 235 mL (Q1-Q3 200-262). We did not register any intra-operative complications or conversions to open surgery. Post-operatively, each one patient suffered a Clavien-Dindo grade 1 (paralytic ileus), grade 2 (blood transfusion), and grade 3 complication (port hernia). After a median follow-up of 7 months (Q1-Q3 4-25), we registered one recurrence, a metachronous transitional cell cancer of the contralateral kidney 24 months after the initial procedure. En-bloc robot-assisted radical cystectomy and nephro-ureterectomy was associated with limited procedure duration, minor blood loss and satisfying intra- and post-operative outcomes.
authors.affiliation: Department of Urology, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Germany. stephan.buse@krupp-krankenhaus.de.|Department of Urology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany. stephan.buse@krupp-krankenhaus.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Buse
authors.affiliation: Department of Urology, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Germany.
authors.forename: Carolin Eva
authors.initials: CE
authors.lastname: Hach
authors.affiliation: Department of Urology, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Germany.
authors.forename: Assen
authors.initials: A
authors.lastname: Alexandrov
authors.affiliation: Department of Urology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Mager
authors.affiliation: Department of Urology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D008297:Male; D000072662:Margins of Excision; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D009392:Nephrectomy / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
keywords: Minimal invasive surgery; Radical cystectomy; Radical nephro-ureterectomy; Robot-assisted laparoscopy; Synchronous transitional cell cancer