V10-09: Surgical Technique of Total Intracorporeal Robot assisted Laparoscopic Pitcher Pot Ileal Neobladder for muscle invasive transitional cell carcinoma of bladder

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Introductions and Objectives
To present our surgical technique in patients who underwent Total Intracorporeal Robot assisted Laparoscopic Pitcher Pot Ileal Neobladder (TIRLPIN) for muscle invasive transitional cell carcinoma of bladder.

Methods
101 patients underwent Robotic Radical Cystectomies from February 2011 to August 2013. Ileal Conduit urinary diversion were done extracorporeally in 44 patients and Neobladders were done extracorporeally in 50 patients. Total Intracorporeal Robot assisted Laparoscopic Ileal conduit was performed in 4 patients and Total Intracorporeal Robot assisted Laparoscopic Pitcher pot Ileal Neobladder(TIRLPIN) were done in 3 patients. [Pitcher pot Ileal Neobladder is a modification of Studer Neobladder which is ileal neobladder in spherical configuration with ileal neourethra (giving the shape of an inverted Indian earthenware container called a ‘pitcher pot’) to circumvent the problem of short mesentery and construct a low-pressure spherical ileal neobladder]. Three patients who underwent robot assisted laparoscopic radical cystectomy extended pelvic lymph node dissection , transposition of left ureter to the right, Pitcher pot ileal neobladder including isolation of 55 cm of ileal loop and bilateral stented uretero-ileal anastomosis in end to side fashion were all performed intracorporeally using the da Vinci Surgical Robot and finally specimen was retrieved. We demonstrate our technique of TIRLPIN with da Vinci Robotic system.

Results
TIRLPIN technically successful in all the 3 patients. Median patient age, body mass index, estimated blood loss were 65 years(range 56-67), 26.2( 23.5-27), 300 ml(280-320ml, respectively. Average operative time was 600 minutes (540-720 min). Average time for the cystectomy was 135 minutes. Mean time to liquid diet was 3.3 days and the stents were removed on seventh day. Perurethral catheter was removed on tenth day in neobladder patients. Median post operative hospital stay was 16 days(12-18 days). 30-day and 90-day complications were Clavien grade 1-2 (n= 3 and 2), clavien grade 3-5 (n= 0 and 0). All patients received Total parental nutrition. One patient had high persistent drain output which resolved after keeping perurethral catheter for extra 1 week. All patients have completed 3 months of follow up.

Conclusions
TIRLPIN for neobladder formation is technically feasible. The robotic system aids in replicating open procedure of reservoir configuration precisely, with reduced perioperative morbidity, minimal blood loss and good cosmetic results.

Funding: None