Robot‐assisted radical cystectomy with intracorporeal Mainz Ⅱ rectosigmoid pouch for muscle‐invasive bladder cancer

Abstract

Background: To report the surgical techniques and results of robot-assisted radical cystectomy (RARC) with intracorporeal Mainz Ⅱ rectosigmoid pouch at our centre. Methods: Two female patients were treated with this procedure. Construction of the pouch was divided into four main steps: incision of the rectum and sigmoid colon, closure of the posterior wall of the pouch, reimplantation of the ureters at the bottom of pouch in an anti-reflux manner, and closure of the anterior wall. Surgical results and perioperative complications were assessed. Results:The operations were performed completely intracorporeally. No perioperative complications were observed. Postoperatively, high-grade invasive urothelial carcinoma was detected. On postoperative day 60, no bilateral ureteral dilation was detected. Two patients demonstrated total continence. Clinical recurrence was not observed during the follow-up period.Conclusions: With careful patient selection, robot-assisted intracorporeal Mainz Ⅱ rectosigmoid pouch might be a simple minimally invasive surgical technique to be evaluated in repeated applications. K E Y W O R D Sbladder cancer, continent urinary diversion, Mainz Ⅱ rectosigmoid pouch, robot-assisted radical cystectomy | INTRODUCTIONWorldwide, bladder cancer is the second most common cancer of the urinary tract and is associated with high morbidity and mortality. Urothelial carcinoma accounts for nearly 90% of all primary bladder tumours. 1,2 Radical cystectomy (RC) is now considered the gold standard for the treatment of muscle-invasive urothelial bladder cancer or high-grade, recurrent non-muscleinvasive bladder tumours. [2][3][4] However, both open radical cystectomy and laparoscopic radical cystectomy with continent or incontinent urinary diversion are standard procedures associated with a risk for severe complications. Conversely, robot-assisted radical cystectomy (RARC) has been reported to reduce morbidity and mortality after RC. Due to inexperience with intracorporeal urinary diversion, most surgeons have performed RARC with extracorporeal urinary diversion. 4 As the technology develops, urinary diversion should be performed intracorporeally along with RC.

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

“…Other variants include modification of the pouch using a seromuscular bowel-flap tube or a full-thickness bowel-flap tube [55,56]. In addition to the classic Mainz pouch, two further variations have been developed: the Mainz pouch II, which uses a rectosigmoid pouch and the Mainz pouch III which instead uses 35-40 cm of ascending and transverse colon to shape the pouch [57,58]. The procedure has been also utilized successfully in minimally invasive surgery [59].…”

Update on robotic cystectomy

“…iRARC was first described in 2003 and has been increasingly adopted at bladder cancer centers of excellence [13]. A variety of different techniques and urinary diversions performed intracorporeally have been recently described, including use of the da Vinci single port system (Intuitive Surgical, Sunnyvale, CA) [14][15][16][17][18][19][20]. Regardless of the technique, iRARC carries a protracted learning curve.…”