Perioperative Outcomes and Complications after Robotic Radical Cystectomy With Intracorporeal or Extracorporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison From a Single-Institutional Prospective Study

Bertolo, Riccardo; Agudelo, José; Garisto, Juan; Armanyous, Sherif; Fergany, Amr; Kaouk, Jihad

doi:10.1016/j.urology.2018.11.059

Cited by 39 publications

(30 citation statements)

References 25 publications

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“…Prior reports including a recent meta‐analysis [7] have found no difference in 90‐day high‐grade complication rates between ORC and RARC. However, most of these studies are limited to ECUD in the robotic arm [7–9] or included <70 ICUD cases [10–13]. Although a recent analysis of the International Robotic Cystectomy Consortium observed an increased incidence of complications for ICUD vs ECUD (high‐grade, 13% vs 10%, P = 0.02) [2], this rate decreased constantly by 2% per year and was lower than for ECUD at the study end in 2015 (6% vs 14%).…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

et al. 2020

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To report a single-institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot-assisted laparoscopic radical cystectomy (RARC). Patients and methods A total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30-and 90-day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. The 5-year overall (OS) and cancer-specific survival (CSS) rates were estimated by Kaplan-Meier plots. Results Most of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD AE98) min, with a median (range) estimated blood loss of 300 (50-2200) mL. Most of the men (86%) received a nervesparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7-48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow-up was 34 (1-170) months, with 30-and 90-day mortality rates of 0%. Clavien-Dindo Grade III-IV complications occurred in 29 of 158 (18%) patients at 30-days and in eight of 158 (5%) between 30-90 days, resulting into a 90-day overall high-grade complication rate of 23%. The unadjusted estimated 5-years recurrence-free survival, CSS and OS rates were 70%, 72%, and 71%, respectively. Conclusion In our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

et al. 2020

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“…ICUD can reduce postoperative complication rates owing to the potential benefits of a smaller incision, reduced postoperative pain, decreased bowel exposure, reduced risk of fluid imbalance and early postoperative recovery 4–6 . Interestingly, some studies about RARC have shown that ICUD reduces the rate of postoperative complications, whereas other studies have shown no significant difference in terms of complication rates between ICUD and ECUD, or worse complication rates in ICUD 4,15–18 …”

Section: Discussionmentioning

confidence: 99%

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

et al. 2020

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Abbreviations & Acronyms ASA = American Society of Anesthesiologists Cr = creatine ECUD = extracorporeal urinary diversion ECUD-IC = extracorporeal ileal conduit urinary diversion ERAS = enhanced recovery after surgery Hb = hemoglobin ICUD = intracorporeal urinary diversion ICUD-IC = intracorporeal ileal conduit urinary diversion IQR = interquartile range LRC = laparoscopic radical cystectomy RARC = robot-assisted radical cystectomy SD = standard deviation Objectives: To compare the perioperative and oncological outcomes of pure laparoscopic intracorporeal ileal conduit urinary diversion versus extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for bladder cancer in a multicenter cohort in Japan. Method: A total of 455 patients who underwent laparoscopic radical cystectomy carried out at 10 institutions were included in this retrospective study. The perioperative data of the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups were compared using the propensity score matching method. The Kaplan-Meier curves were obtained to elucidate time to ureteroenteric stricture, reoperation, recurrence and survival. Results: In total, 72 matched pairs were evaluated for the final analysis. The median follow-up period was 28 and 23 months in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively. The operative time in the intracorporeal ileal conduit urinary diversion group was approximately 1 h longer than that in the extracorporeal ileal conduit urinary diversion group. The early and late postoperative complication rates were similar in both groups, except for the reduced wound-related complication rates in the intracorporeal ileal conduit urinary diversion group. The median days to regular oral food intake were 4 and 5 days in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively (P = 0.014). No significant difference was noted in the occurrence of ureteroenteric strictures and reoperation rate. Furthermore, recurrence-free, cancerspecific, and overall survival rates and recurrence patterns did not significantly differ. Conclusions: Laparoscopic intracorporeal ileal conduit urinary diversion is a safe, feasible and reproducible procedure with similar postoperative complication rates, ureteroenteric stricture rate and oncological outcomes when compared with extracorporeal ileal conduit urinary diversion, but faster postoperative bowel recovery and decreased wound-related complication rates.

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“…Compared to other series, our mean operative time was somewhat longer, which is to be expected considering the intricacy and natural learning curve of using the system . In two cases, we used an additional port on the previously marked stoma site to perform the intracorporeal urinary diversion and steps were replicated with no issues reported from the previously described institutional standardised technique . We emphasise that a learning curve exists to perform a single‐port RARC with differences experienced in port placement, docking, suturing, and system operation.…”

Section: Discussionmentioning

confidence: 81%

Step‐by‐step technique for single‐port robot‐assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci^® SP™ surgical system

et al. 2019

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Objectives To describe a step‐by‐step technique for robot‐assisted radical cystectomy (RARC) with pelvic lymph node dissection (PLND) performed using the da Vinci® SP™ surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients and Methods Four consecutive patients diagnosed with urothelial carcinoma of the bladder were counselled for RARC with PLND and ileal conduit urinary diversion performed using the da Vinci SP surgical system. A 3‐cm midline incision was made 5‐cm above the umbilicus. Dissection was performed to access the abdominal cavity. Insertion of the GelPOINT® advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) with the SP Cannula was performed through the incision made. A 12‐mm AirSeal® (SurgiQuest Inc., Milfort, CT, USA) port for the assistant was placed on the pre‐marked stoma site, where an ileal conduit urinary diversion was desired. Demographics and perioperative outcomes were collected under Institutional Review Board approval (IRB 13‐780). The surgeries were performed by reproducing the steps of the institutional approach for RARC performed with the multi‐arm robotic platform. Results The surgeries were successfully completed. There was neither conversion to standard multi‐arm robotic or open approaches nor the need for additional port placement. The mean (range) operative time was 454 (420–496) min. Blood loss averaged 312 mL. No transfusions were required and no intraoperative complications occurred. All patients had negative surgical margins. All patients were discharged on postoperative day 5. Conclusion From our preliminary experience, RARC with PLND and ileal conduit urinary diversion is feasible and safe using the da Vinci SP surgical system. Further comparative studies with open and multi‐arm robotic approaches are warranted.

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Perioperative Outcomes and Complications after Robotic Radical Cystectomy With Intracorporeal or Extracorporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison From a Single-Institutional Prospective Study

Cited by 39 publications

References 25 publications

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

Step‐by‐step technique for single‐port robot‐assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci^® SP™ surgical system

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Perioperative Outcomes and Complications after Robotic Radical Cystectomy With Intracorporeal or Extracorporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison From a Single-Institutional Prospective Study

Cited by 39 publications

References 25 publications

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

Step‐by‐step technique for single‐port robot‐assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci® SP™ surgical system

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Product

Resources

About

Step‐by‐step technique for single‐port robot‐assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci^® SP™ surgical system