V10-13: Robotic Radical Cysto-Prostatectomy and Bilateral Pelvic lymph Node Dissection with Studer Ileal Neo-Bladder: Step-Wise Video Demonstration

Video

Introductions and Objectives
Robotic assisted radical cystectomy (RARC) for cancer is gaining wider acceptance among urologists and patients. RARC may reduce morbidity after cystectomy Yet, the concomitant urinary diversion is typically performed extracorporeally at most centers, primarily because intra corporeal diversion is technically complex. The aim of this report is to present a video highlighting the steps of procedure with our initial experience of RARC with complete intra corporeal studer ileal neobladder.

Methods
We have performed 21 RARC in our institute during last one year in our institute by one surgeon for invasive transitional cell carcinoma of urinary bladder. Out of which total intracorporeal studer ileal neobladder was done in three patients and all were male patients. Intracorporeal studer ileal neobladder creation followed by intracorporeal anastomosis of neobladder and urethra was done by using Da Vinci Si HD (Intuitive surgicals, USA) system. All were completed successfully without conversion to open surgery. Our surgical technique is demonstrated in the accompanying video.

Results
Median patient age, operative time, estimated blood loss, hospital stay and lymph node yield were 58 yrs (range: 47-72), 480 min (range: 410-720), 600 ml (range: 500-800), 11 days (range: 10-12 days) and 18 (range: 12-23), respectively. None of the patients received blood transfusions and required ICU stay. One patient has diagnosed with positive lymph nodes. Surgical margins were negative in all three patients. No post operative complications were observed. Patients were disease free after follow up of 10 and 6 months. The study is limited by a relative small sample size and no comparative group and is our initial experience.

Conclusions
RARC with total intracorporeal neobladder is a complex procedure, but it can be performed safely, with a structured and stepwise approach. Our initial experience is encouraging. However less blood loss, shorter hospital stay and other advantages makes it an option for the patients. This study is limited by small number of patients and short follow-up period.

Funding: none