V10-08: POSSIBLE COMPLICATIONS DURING ROBOTIC CYSTECTOMY AND HOW TO AVOID THEM

Video

Introductions and Objectives
Bladder cancer is the fourth most common tumor in men in the United States. Radical cystectomy is a complex procedure with a high complication rate. Ninety-day complication rate of robotic radical cystectomy was similar to open radical cystectomy in a recent randomized trial however robotic radical cystectomy is technically demanding and the anticipation of possible complications is crucial to prevent their occurrence. Herein, we discuss possible complications in each step of robotic radical cystectomy.

Methods
The present study is an analysis of recorded videos from robotic radical cystectomies with focus on possible complications and tips to avoid them. Surgical steps are divided into patient positioning and port placement, docking of robot, ureteral dissection, posterior dissection, apical dissection, lymphadenectomy and urinary diversion. In each step, anatomical landmarks are examined and potential complications are noted. Various options of instruments used during surgery are noted.

Results
We show strategies to prevent possible intraoperative complications that can occur in each step of robotic radical cystectomy, including nerve, vascular and visceral injuries. We also present some key technical points that can be helpful to avoid postoperative complications. Results obtained with the application of these lessons have led to continuous improvement of operative outcomes in our center.

Conclusions
Robot-assisted radical cystectomy and urinary diversion has numerous surgical steps with potentially high risk for complications. Due to the technically complex nature of this procedure, the awareness of potential complications during each step is extremely important to prevent their occurrence.

Funding: none