Evaluation of robot-assisted laparoscopic versus open cystectomy and effect of carbon dioxide-pneumoperitoneum on histopathological findings in ureteroenteric anastomoses: results from an experimental randomized porcine study.
OBJECTIVE
The aim of this study was to investigate the histopathology of ureteroenteric anastomoses (UEAs) after radical cystectomy (RC) with an ileal conduit in a porcine model using different surgical techniques. The study also evaluated the potential anti-inflammatory effect of preoperative carbon dioxide-pneumoperitoneum (CO2P).


METHODS
Forty female Danish Landrace pigs were randomized to four groups: three intervention groups [open surgery ± prior CO2P and robot-assisted laparoscopic cystectomy (RALC)], all subjected to RC and an ileal conduit, and one control group. After euthanization, UEAs were harvested and histopathologically evaluated.


RESULTS
Five pigs were excluded from the study owing to postoperative complications. Operating room time and clamping of the right and left ureters were significantly longer in the robotic than in the open groups (p < .01). Inflammatory infiltration grade of the left ureter was significantly higher in RALC (p = .032). No statistically significant difference was observed between the open groups receiving prior CO2P or not.


CONCLUSIONS
Results showed a statistically significant higher inflammatory infiltration grade of the left ureter in RALC, emphasizing the importance of using meticulous techniques when mobilizing the left ureter using the robot. It was not possible to conclude with certainty whether CO2P could constitute an anti-inflammatory agent for local inflammation.
a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.|b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark.
Pernille Skjold
PS
Kingo
a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.
Thormod Mønsted
TM
Rasmussen
b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark.
Rikke
R
Nørregaard
a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.|b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark.
Michael
M
Borre
c Department of Pathology , Aarhus University Hospital , Aarhus , Denmark.
Søren
S
Høyer
a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.
Jørgen Bjerggaard
JB
Jensen
D000714:Anastomosis, Surgical; D000818:Animals; D002245:Carbon Dioxide; D015653:Cystectomy / Q000379:methods*; D005260:Female; D007082:Ileum / Q000473:pathology / Q000637:transplantation*; D007249:Inflammation; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications; D011897:Random Allocation; D065287:Robotic Surgical Procedures / Q000379:methods*; D034421:Sus scrofa; D013552:Swine; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
D002245:Carbon Dioxide
Comparative study; cystectomy; disease model animal; minimally invasive surgical procedure; pathology