title: Robot-assisted approach to 'W'-configuration urinary diversion: a step-by-step technique.
abstract: To describe a detailed step-by-step approach of our technique for robot-assisted intracorporeal 'W'-configuration orthotopic ileal neobladder.
  
  
  
  Five patients underwent robot-assisted radical cystectomy (RARC), extended pelvic lymph node dissection and intracorporeal neobladder (ICNB). ICNB was divided into six key steps to facilitate and enable a detailed analysis and auditing of the technique. No conversion to open surgery was required. Timing for each step was noted. All patients had at least 3 months of follow-up.
  
  
  
  The mean age was 57 years. The mean overall console and diversion times were 357 and 193 min, respectively. None of the patients had any evidence of residual disease after RARC. Four of the five patients had complications; three developed fevers due to urinary tract infections (one required readmission), and one developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularisation and construction of the posterior plate were consistently the longest among the key steps (average 46 min, 13% of the overall operative time), followed by uretero-ileal anastomosis (37 min, 10%), neobladder-urethral anastomosis (23 min, 6%), and identification and fixation of the bowel (26 min, 7%).
  
  
  
  We described our step-by-step technique and initial perioperative outcomes of our first five ICNBs with 'W' configuration.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Youssef E
authors.initials: YE
authors.lastname: Ahmed
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Justen D
authors.initials: JD
authors.lastname: Kozlowski
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: May
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nyquist
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sexton
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Curtin
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Department of Urology and Nephrology, Mansoura University, Mansoura, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Khurshid A
authors.identifier: 0000-0002-4551-4676
authors.initials: KA
authors.lastname: Guru
mesh_terms: D015653:Cystectomy / Q000379:methods; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D014547:Urinary Diversion
keywords: Hautmann; W-configuration; intracorporeal; neobladder; orthotopic urinary diversion; robot-assisted radical cystectomy