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The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. Materials and Methods: We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated.Results: One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12−49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I−II) and 29% (n = 17) major complications (Clavien III−V). Three patients died in the early postoperative period.Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre-and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1−2). Conclusion:Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic

INTRODUCTION AND OBJECTIVES: Robotic assistance enables the treatment of Renal Cell Carcinoma with vena cava involvement in a minimally invasive fashion. The objective of this video is to show the feasibility and present the technical steps of such a procedure for a retro-hepatic level 2 thrombus. METHODS: The surgery was performed with the Da-Vinci surgical robot, by using 3 operatives arms, a 30-degree endoscope and two ports for the assistant. Intraoperative ultrasound was used to determine the exact limits of the thrombus. Clinical data, collected after consent, were extracted from the french national database on kidney cancer UroCCR.RESULTS: A 10 cm right renal tumor was diagnosed after full work-up of gross hematuria in a 73 years-old patient. The tumor was associated with a lymph node (hilar, retrocaval, para-aortic) and venous invasion (9cm level 2 IVC thrombus). A 15mm single pulmonary lesion was suspicious for metastasis. Clinical stage was cT3bN2M1.The first step consisted in the exposure of the vena cava and the inter-aorto-caval dissection performing the node dissection in the same time. The left renal vein was encircled with a Rummel tourniquet and the two right renal arteries were clipped. An intraoperative ultrasound was performed to identify the limits of the thrombus revealing its proximal extension in the infra-renal part of the vena cava up to the iliac division. The sequential clamping of the vena cava was initiated from low to top before a 20cm long opening of the IVC. The lower and cruoric part of the thrombus was removed and placed in an endobag whereas the tumor part was removed in monobloc with the specimen. A resection of the vena cava was performed for wall invasion suspicion and 4 Prolene 4.0 running sutures were used to close the cavotomy. Blood Loss was 100cc.The pathology reported a pT3bN2R0 type 2 papillary renal cell carcinoma, with capsular rupture. Follow-up showed a metastatic progression treated by anti-EGFR therapy.CONCLUSIONS: The minimally invasive treatment of right renal cell carcinoma retro-hepatic level 2 thrombus appears to be feasible. The expected benefits are a blood loss reduction and faster post-operative recovery.