Robotic-Assisted Laparoscopic Intracorporeal Urinary Diversion

Lamb

et al. 2017

European Urology Focus

In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion. European Urology Focus, (doi:10.1016Focus, (doi:10. /j.euf.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/145598/ RESULTS AND LIMITATIONSThe 90-day all complication rate following ileal conduit and continent diversion was 68% and 82.4% while major complications were 21.0% and 20.6% respectively. 90-day mortality was 3% and 2.9% for ileal conduit and continent diversion patients respectively. On multivariate analysis, blood transfusion requirement was independently associated with major (p=0.002) and all 30-day (p=0.002) and 90-day major complications (p=0.012) while male patients were associated with 90-day major complications (p=0.015). Critical analysis identified surgical complications was responsible for 39.4% of all 90-day major complications. PATIENT SUMMARYIn this report, we looked at the surgical outcomes in bladder cancer patients treated with minimal invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from different center even in a randomised trial setting.

Section: Discussionsupporting

confidence: 76%

In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion

Lamb

et al. 2017

European Urology Focus

“…12 Since then, few robotic intracorporeal neobladders have been performed. 5,11,13 Most units perform an extracorporeal urinary diversion. 2,3,14 We maintained the open surgical principles of reconstruction based on the Studer technique.…”

Section: Discussionmentioning

confidence: 99%

“…However, their results combined 9 intracorporeal ileal conduits with the 3 neobladders. 13 These series are limited by the small numbers and short follow-up. The estimated blood loss ranged from 250 to 600 mL, but can be as high as 2200 mL.…”

Section: Figmentioning

confidence: 99%

Canada’s First Robotic Assisted Totally Intracorporeal Orthotopic Ileal Neobladder

Haddad

Richard

Bladou

2013

CUAJ

Despite robotic-assisted radical cysto-prostatectomy being performed in several centres, the urinary diversion is most often performed extra-corporeal. A robotic intra-corporeal ileal neobladder is technically demanding and long-term functional outcome data is lacking. We performed a robotic intra-corporeal ileal neobladder in a 73-year-old man for muscle invasive non-metastatic bladder cancer. The total operative time was 6 hours 8 minutes. The estimated blood loss was 900 mL. There were no complications and he was discharged on day 12. The principles of open neobladder surgery were maintained, however key modifications were used to reduce technical difficulty and enable timely completion. We found that robotic intracorporeal ileal neobladder can be safely performed with an experienced robotic unit.

Int J Cancer Ther Oncol

“…Using this template the surgeon will be able to excise the external iliac, obturator, hyogastic and common iliac. Some authors 5 recommend the excision of the presacrallymphnode as the excision of this lymph node group facilitates the transposition of the left ureter behind the sigmoid mesentery to aid in intracorporeal anastomosis.…”

mentioning

confidence: 99%

“…An OC is associated with high rates of morbidity (19-64%) or mortality (6-11%), although there is a wide variation in current literature. [1][2][3][4][5][6][7][8][9][10][11] A RRC is perhaps just one modality in a raft of measures to try reducing mortality and morbidity of a cystectomy.…”

mentioning

confidence: 99%

Robotic Cystectomy : Important considerations before commencing the procedure independently

Vasdev

Lamb²,

Lane³

et al. 2013

A radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the gold standard for the management of the appropriately selected patient with muscle invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC)/carcinoma in situ (CIS) who fail appropriate intravesical therapy. In the last decade, Robotic Radical Cystectomy (RRC) is being performed in a large number of international Centre's with the published advantages of decreased blood loss, improved post-operative convalescence and earlier initiation of adjuvant therapy 1 when compared to open cystectomy (OC). Current literature indicates that a RC is equivalent to OC from the oncological perspective. An OC is associated with high rates of morbidity (19-64%) or mortality (6-11%), although there is a wide variation in current literature. 1-11 A RRC is perhaps just one modality in a raft of measures to try reducing mortality and morbidity of a cystectomy.To the Robotic Urological Surgeon, a RRC comes with numerous specific challenges. Questions that arise at the time of commencing a RRC include the learning curve of the procedure, learning steps to enhances ones speed to perform the procedure efficiently and safely, level of lymphnode dissection, whether one should embark of performing an intracorpealileal conduit or neobladder formation and the cost of commencing a RRC service. The patient's postoperative management is the most important step to ensure that the post-operative complications are kept to a minimum using a multi-disciplinary team (MDT) approach.In current literature high volume centers with experienced surgeons have reported patient outcomes that are acceptable from the perspective of extended pelvic lymph node dissection, positive surgical margin rates and highlight that patients are not being compromised from the surgical perspective in undergoing a RC. 2 The learning curve of a RRC is not as clearly defined in comparison to Robotic Radical Prostatectomy (RRP). Before commencing aRRC it is important to be proficient and familiar with robotic pelvic surgery. Most robotic surgeons are proficient in RRP before embarking on performing independent RRC. Hayn et al. 3 have indicated that an acceptable level of proficiency to perform a RRC is established after the 30 th case by measuring post-operative parameters such as operative time, lymph node yield (LNY), estimated blood loss (EBL), and margin positivity. At our center we commenced performing RC after performing 150 Robotic RRP. We would strongly recommend that a robotic urological surgeon who is keen to commence Robotic RC should be proficient in robotic RRP and in performing an extended pelvic lymph node dissection (EPLND). A well-trained Robotic Team consisting of the lead experience console surgeon, experienced assistant, nursing staff and an experience anesthetist is essential for the commencement of a RRC program. The techniques that a team needs to develop to aid in improving intra-operative times including a fast docking/ undocking time, piggyback techniques for por...