V2-01: Robot Assisted Intracorporeal Ileal Conduit: Simplified Step-By-Step Technique
VideoIntroductions and Objectives
Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has been recently introduced as a minimally invasive alternative to the “gold-standard” open approach treatment for invasive bladder cancer. Our objective was to describe a simplified technique of robotic intracorporeal ileal conduit (IC) and to report early and intermediate outcomes of the procedure.
Medical charts of consecutive patients who underwent RARC with intracorporeal IC in our tertiary care between February 2011 and May 2013 were reviewed from a prospectively maintained, institutional review board-approved database. Patients underwent RARC, extended lymphadenectomy and intracorporeal IC. The critical steps of our standardized technique for robotic intracorporeal IC are illustrated in the accompanying video. Patients’ demographics, main surgical parameters and short-term outcomes were analyzed. Postoperative complications were graded according to the to the Memorial Sloan-Kettering Cancer Center (MSKCC) complication grading system.
A total of 31 patients (mean age 66.5±14.1 years) were included in this analysis. Mean operative time, estimated blood loss, and length of stay were respectively 401 ± 88 min, 327 ± 154 ml, and 9.6 ± 4.4 days. Complications occurred in 38.7% of which; 32.2% were postoperative with 25.8% and 6.4% of the patients experiencing minor (grade 1-2) and major (grade 3-5) complications respectively. Readmission and secondary procedure were 16.1% and 6.4% respectively.
Robotic intracorporeal ileal conduit is technically challenging but feasible. A simplified standardization of the surgical technique facilitates the procedure to be reproduced and widely implemented safely with excellent surgical outcomes.