Robot-Assisted Intracorporeal Orthotopic Ileal Neobladder: Description of the “Shell” Technique

Abstract

Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (ICNB) remains a very complicated, technically demanding and time-consuming surgical procedure. In the current study we describe our robot-assisted intracorporeal “Shell” neobladder reconstruction. Methods: From January 2017 to December 2019, we performed 30 intracorporeal ileal neobladder “Shell” reconstructions. We prospectively collected demographics and clinical and pathological data and retrospectively analysed perioperative, functional and oncological outcomes. Results: No conversion to open surgery or intraoperative blood transfusion was necessary. The median whole operative time was 493 min (IQR 433–530 min), ranging from 514 min (IQR 502–554 min) recorded during the first ten procedures to 470 min (IQR 442–503 min) of the last ten. The median estimated blood loss was 400 mL (IQR 350–700 mL). The median length of stay was 11 days (IQR 10–17). Both early and late complication rates were 46.7%. The high-grade early complication rate accounted for 20%, while the high-grade late complication rate was 30%. The daytime continence rate registered was 73.3%, while night-time continence rate was 60%. Conclusions: Our results demonstrated “Shell” neobladder reconstruction as a technically feasible procedure, with good functional outcomes in tertiary referral centre. Longer follow-up and larger populations are needed to validate these preliminary results.

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

“…A total of 10 cm of the anterior plate is then sutured in order to shape the neck of the neobladder while ureters are anastomosed posteriorly. Finally, the posterior plate is folded anteriorly, in a shell-like manner, and sutured to the anterior plate [121].…”

Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology

“…39 Since then, many other ICNB reconstructive techniques have been adopted in an attempt to reduce operative time, such as the Studer 'U' modified neobladder, 40 the 'Y' neobladder, 41,42 the Padua neobladder, 43 and the Shell neobladder. 44 In the systematic review by Karthik et al, a total of 2593 patients underwent robotic assisted radical cystectomy with diversion in six studies. The intracorporeal cystectomy group involved 1334 patients, of which only 22% had neobladder as compared to IC (78%).…”

“… 39 Since then, many other ICNB reconstructive techniques have been adopted in an attempt to reduce operative time, such as the Studer ‘U’ modified neobladder, 40 the ‘Y’ neobladder, 41 , 42 the Padua neobladder, 43 and the Shell neobladder. 44 …”

Laparoscopic Radical Cystectomy with Ileal Orthotopic Neobladder for Bladder Cancer: Current Indications and Outcomes

“…Bianchi et al [ 18 ] retained the advantages and improved on the limitations of the pyramidal neobladder, Gaston’s Y-shaped neobladder, and Koie’s neobladder reconstruction techniques by using a unique craniocaudal running suture to form the neobladder’s posterior wall. Next, the authors used two-directional sutures to reconfigure the anterior wall, creating a spherical shape.…”

“…Finally, they anastomosed the ureter to the posterior wall of the neobladder to form a modified detached papilla with separate sutures without using an additional anti-reflux technique ( Fig. 3 ) [ 18 ]. The resulting “Shell” neobladder can maintain its spherical shape, reducing its intracavitary pressure.…”