Simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy: technique description, outcomes, and literature summary

Abstract

The objectives of this study are to describe the surgical technique for simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy, to report its surgical bench marks, and finally, to summarize the current evidence on the procedure. After written informed consent, we prospectively enrolled consecutive patients undergoing simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy in a prospective institutional database. We performed all procedures with robotic assistance from the DaVinci Si-HD, a four-arm robotic system. Endpoints included surgery duration, estimated intra-operative blood loss, resection margins, intra-, and post-operative complications. Furthermore, we describe oncological outcome at follow-up. We conducted six (54.4 %) right-sided and five (45.5 %) left-sided nephro-ureterectomies. Urinary diversion consisted in nine (81.2 %) ureterocutaneostomies and in two (18.8 %) ileum conduits. The median surgery duration was 287 min [interquartile range (Q1-Q3) 253-328], thereof 196-min console time (Q1-Q3 158-230). The median-estimated blood loss was 235 mL (Q1-Q3 200-262). We did not register any intra-operative complications or conversions to open surgery. Post-operatively, each one patient suffered a Clavien-Dindo grade 1 (paralytic ileus), grade 2 (blood transfusion), and grade 3 complication (port hernia). After a median follow-up of 7 months (Q1-Q3 4-25), we registered one recurrence, a metachronous transitional cell cancer of the contralateral kidney 24 months after the initial procedure. En-bloc robot-assisted radical cystectomy and nephro-ureterectomy was associated with limited procedure duration, minor blood loss and satisfying intra- and post-operative outcomes.

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

“…The mid-term oncological outcomes were in line with the survival estimates for urothelial bladder cancer [21,22]. As such, these findings support the findings from previous reports [6][7][8][9][10][11] regarding surgical safety while adding information in terms of midterm oncological outcomes.…”

“…We performed all procedures with robotic assistance from the DaVinci Si-HD ® system (Intuitive Surgical, Inc., Sunnyvale, US), a four-arm robotic system. We have previously described in detail our technique for simultaneous enbloc robot-assisted radical cystectomy and nephro-ureterectomy [6]. Briefly, with the patient in a 60-degree flank position, we introduced 5 ports for transperitoneal nephro-ureterectomy preparation and prepared the ureter and the renal hilum.…”

“…UCST was conducted in palliative situations, in patients with severe comorbidities either to limit the operative duration or to avoid bowel resection in patients at high risk for anastomotic complications, or based on patient-specific considerations [6] after a detailed discussion of the benefits and risks with the individual patients prior to surgery.…”

“…Combined lower and upper urinary tract resection is warranted in these patients. While data describing the surgical benchmarks of simultaneous enbloc robotassisted radical cystectomy and nephro-ureterectomy [6][7][8][9][10][11] have been reported, information on mid-term oncological outcomes is lacking.…”

Outcomes and Complications of Simultaneous Laparoscopic Cystectomy and Laparoscopic Nephroureterectomy with Umbilical Reduced Port Surgery

“…The entire specimen was removed through a supraumbilical or infraumbilical incision. Recently, Buse et al, (2016) described 11 cases of robot-assisted simultaneous radical cystectomy and nephroureterectomy that required 7-8 ports in all procedures. To minimize the surgical trauma, we preferred to extract the intact specimen through a Pfannenstiel incision in our male patients.…”