V6-07: Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: surgical technique, perioperative and early functional outcomes of a prospective single center series
Robot assisted radical cystectomy (RARC) with totally intracorporeal orthotopic neobladders is a challenging surgical procedure. The potentially increased risk of neobladders stone formation consequent to the use of staplers to create the neobladders is still a matter of debate. Robotic staplers have been recently made commercially available. In this prospective study (www.clinicaltrials.gov NCT02665156) we assessed the feasibility, safety and time efficiency of RARC with intracorporeal partly stapled “Padua Ileal Bladder” using robotic staplers.
Twenty-two consecutive patients with muscle invasive or high grade recurrent urothelial carcinoma of the bladder were treated between March 2016 and October 2016. Baseline, perioperative and follow-up data were prospectively collected and maintained into an IRB approved database. Key steps of surgery include: selection of 45 centimeters of ileum and division of the distal and proximal part of the ileum using robotic staplers; detubularization of the ileal loop; creation of the neo-bladder neck with one stapler load; double folding of the proximal ileal loop using two-three stapler loads; hand-sewing of the posterior neobladders wall with barbed suture; uretero-ileal anastomoses on JJ stents with a modified split-nipple technique; urethroneobladder anastomos is performed according to Van Velthoven; hand-sewing of the anterior neobladders wall with barbed suture.
All procedures were successfully completed; open conversion was never necessary. Median total operative time (“skin to skin”) was 270 minutes (IQR:255-295). Operative time was
We first report safety and time efficiency in the use of robotic staplers to create orthotopic neobladder. This preliminary report highlights feasibility of this technique and favorable perioperative and functional outcomes._x000D_ _x000D_