V05-04: ROBOT ASSISTED TOTALLY INTRACORPOREAL VESCICA ILEALE PADOVANA (ra-VIP): A NEW TECHNIQUE FOR ROBOTIC BLADDER REPLACEMENT
The Vescica Ileale Padovana (VIP) was described first in 1989 as a technique for total bladder replacement.Robot assisted radical cystectomy (RARC) has been proved to be a valid approach to reduce morbidity improving the recovery. Intracorporeal, extracorporeal and hybrid technique of UD after RARC have been reported for both continent and incontinent diversion. Herein we report preliminary results and a detailed step-by-step surgical technique description of robot assisted Vescica Ileale Padovana (ra-VIP) that replicates the open technique principles.
We prospectively analysed of consecutive patients who underwent robot assisted radical cystectomy and totally intracorporeal ra-VIP at our Institution from April 2015 to March 2017. All the procedures were performed by the same surgeon (A.W). Data analysis included perioperative outcomes (operating time, blood loss, transfusion rate, hospital stay), early ( 90 days) postoperative complications using the Clavien-Dindo system, readmission rate at 30 days, pathology as well as oncologic outcomes. Furthermore, cancer specific survival (CSS) and overall survival (OS) were reported
In total 15 patients underwent RARC and ra-VIP of which 14 were male and 1 female. The mean (SD) age was 58.4 yrs (9.6). The mean (SD) BMI was 24.8 (3.1). The mean (SD) ASA score was 2.1 (0.5). No patient underwent prior chemotherapy or pelvic. surgery and radiation. All the procedures were completed without open conversion and the neobladder replacement was completed totally intracorporeally in all the cases evaluated. The mean (SD) operative time was 369.6 (65.8) min and the mean (SD) estimated blood loss was 356 ml (108.6). The median hospital stay was 17 days. No patient received intraoperative transfusions. Only 3 patients received postoperative transfusions. Five patient had 30 days major (Clavien-Dindo? 3) postoperative complications. One patient was readmitted after discharge. One patients reported a long term sequela (loss of kidney secondary to ureteral benign stricture). No positive margins were reported. At last follow-up 100% of patients were alive
Our preliminary results showed that the ra-VIP appears to be a feasible and successful technique for robot assisted totally intracorporeal bladder replacement following robotic radical cystectomy. A wider series with longer follow-up is needed to evaluate long term functional outcomes and voiding dynamics.