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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Robot‐assisted (RA) procedures are increasingly being performed as minimally invasive surgical approaches. RA radical cystectomy (RARC) has the advantages of decreased blood loss, decreased time to flatus, decreased time to bowel movement and decreased analgesic use compared with open RC. Positive surgical margin rates and lymph node yields are similar to open RC. RARC was suggested to have the advantage of having fewer complications compared with open RC. To date, very few authors have reported their experience with totally intracorporeal RARC including the urinary diversion. This case series of totally intracorporeal RARC including the urinary diversion reports the operative and postoperative variables, pathological variables, complications, oncological outcomes, functional outcomes and the feasibility of these complex procedures. Advantages of using the surgical robot enable the console surgeon to preserve the neurovascular bundles with excellent surgical oncological safety. Outcomes of the present series suggest that RARC seems to have excellent short‐term surgical and pathological outcomes and satisfactory functional results. Additionally, performing the whole procedure totally intracorporeally might lead to decreased insensible fluid loss from the bowels, which might also prevent development of electrolyte imbalance resulting in earlier bowel function recovery. Additional advantages of this approach include decreased wound infection and dehiscence, better wound healing and better cosmesis. OBJECTIVE To report the outcomes of 27 patients whom we performed robot‐assisted radical cystoprostatectomy and cystectomy (RARC) with intracorporeal urinary diversion (Studer pouch and ileal conduit) for bladder cancer. PATIENTS AND METHODS Between December 2009 and December 2010, we performed RARC in 25 men (intrafascial bilateral [22], unilateral [one], non‐neurovascular bundle [NVB] sparing [two]), NVB‐sparing RARC with anterior pelvic exenteration in two women, bilateral extended robot‐assisted pelvic lymph node dissection (RAPLND) (25), intracorporeal Studer pouch (23), ileal conduit (two), and extracorporeal Studer pouch (two) construction. Patient demographics, operative and postoperative variables, pathological variables, complications (according to modified Clavien system) and functional outcomes were evaluated. RESULTS The mean (sd, range) operative duration, intraoperative estimated blood loss and mean lymph node (LN) yield were 9.9 (1.4, 7.1–12.4) h, 429 (257, 100–1200) mL and 24.8 (9.2, 8–46), respectively. The mean (sd, range) hospital stay was 10.5 (6.8, 7–36) days, there was one perioperative death (3.7%), lodge drains were removed at a mean of 11.3 (5.6, 9–35) days and surgical margins were negative in all but one patient who had pT4b disease. The postoperative pathological stages were: pT0 (five), pTis (one), pT1 (one), pT2a (five), pT2b (three), pT3a (six), pT3b (two), pT4a (three) and ...

To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robotassisted radical cystectomy (RARC). Patients and MethodsWe retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90-day high-grade complications (Clavien-Dindo Classification Grade ≥III), and 90-day readmissions after RARC. ResultsUtilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high-grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and

Laparoscopic ureteral reimplantation is an effective procedure with good medium-term results. We believe that this procedure will become an established treatment option.

One proposed solution is to use artificial intelligence (AI)-based detection systems.With the help of machine learning, classification algorithms can be trained to predict results and outcomes, provided that enough training data are available. In 2017, we at the National Cancer Institute [7] proposed an AI system based on intensity and texture analysis and a random forest classification algorithm. This system was validated in a large multireader multicenter study in 2018 [8]. Results of that study revealed an increase in detection of transition zone lesions among moderately experienced readers only. Overall, however, the AI system was equivalent to conventional MRI interpretation [8]. In that study, color-coded prediction maps were used to draw attention to AI-detected lesions. Feedback from the study suggested that prediction maps compromised the interaction between the radiologists and the AI system with resultant decreased accuracy for some readers. To address this issue a new AI detection system with more expert annotated