V05-01: FLORENCE ROBOTIC INTRACORPOREAL NEOBLADDER (FLORIN). A NEW CONFIGURATION USING STRATEGY DEVELOPED FOLLOWING THE IDEAL GUIDELINES
To describe our step-by-step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, according to the IDEAL Collaboration guidelines.
FloRIN neobladder was performed after the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro-ileal anastomosis creating an asymmetrical U shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an L; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero-enteral "orthotopic" bilateral anasthomosis. The idealization and development of FloRIN followed IDEAL guidelines recommended stages: Phase 1 (simulation) consisted in the neobladder robotic configuration on silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardization in ten consecutive robotic approaches. Phase 2a and 2b included urodynamical and imaging assessment of patients treated.
From February 2016 to September 2017 FloRIN was performed in 18 patients. Comparing the first 3 (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartiles) reconstruction operating time was 260 (220-340) vs 160 (150-210) min, respectively. Postoperative complications occurred in 4/18 (22.1%) patients, including one surgical Clavien 3 and three medical Clavien 2, respectively. The urodynamic examination (available in 9 [50%] patients) showed median (interquartiles) reservoir cystometric capacity, compliance, and post-void residual of 240 (220-267) mL, 18 (12.5-19.8) ml/cmH2O, and 0 (0-50) mL, respectively. Ultrasound showed no Grade ?2 vesicoureteral reflux.
We describe FloRIN neobladder, concluding its technical feasibility with acceptable time efficiency. The first cases studied showed good reservoirs capacity, low pressure with no reflux, and complete voiding.