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Piramide F, Turri F, Amparore D, Fallara G, De Groote R, Knipper S, Wuernschimmel C, Bravi CA, Lambert E, Di Maida F, Liakos N, Pellegrino F, Andras I, Mastrorosa A, Tillu N, Mastroianni R, Paciotti M, Wenzel M, Bianchi R, di Trapani E, Moschovas MC, Gandaglia G, Moschini M, D'Hondt F, Rocco B, Fiori C, Galfano A, Minervini A, Simone G, Briganti A, De Cobelli O, Gaston R, Montorsi F, Breda A, Wiklund P, Porpiglia F, Mottrie A, Larcher A, Dell'Oglio P. Atlas of Intracorporeal Orthotopic Neobladder Techniques After Robot-assisted Radical Cystectomy and Systematic Review of Clinical Outcomes. Eur Urol 2024; 85:348-360. [PMID: 38044179 DOI: 10.1016/j.eururo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. OBJECTIVE To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. DESIGN, SETTING, AND PARTICIPANTS We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. SURGICAL PROCEDURE Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. MEASUREMENTS Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. RESULTS AND LIMITATIONS Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. CONCLUSIONS Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. PATIENT SUMMARY Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others.
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Affiliation(s)
- Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Fallara
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Sophie Knipper
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Edward Lambert
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Nikolaos Liakos
- Department of Urology, Medical Faculty and Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandro Mastrorosa
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France; Urology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Neeraja Tillu
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco Paciotti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Bernando Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autònoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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Shimizu F, Muto S, Kitamura K, China T, Shirakawa T, Kimura T, Ieda T, Nagata M, Isotani S, Nakagawa Y, Horie S. Robot-Assisted Radical Cystectomy with Modified Vesica Ileale Padovana (VIP) Neobladder Configuration Using a Hybrid Approach: Initial Experience. J Pers Med 2023; 13:jpm13050802. [PMID: 37240972 DOI: 10.3390/jpm13050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE We developed a new technique to fold a neobladder (NB) simply by using a modified Vesica Ileale Padovana (VIP) with a hybrid approach. We provide a step-by-step description of our technique as it was used in this initial experience. METHODS A total of 10 male patients with a median age of 66 years underwent robot-assisted radical cystectomy (RARC) with an orthotopic NB via a hybrid approach from March 2022 to February 2023. After the isolation of the bladder and bilateral pelvic lymphadenectomy, Wallace plate creation was performed, and the robot was undocked. We extracorporeally performed the removal of the specimen and a side-to-side ileoileal anastomosis, and then the VIP NB posterior plate was rotated 90 degrees counterclockwise using a 45 cm detubularized ileum. The robot was redocked; then, circumferential urethra-ileal anastomosis, side-to-middle anterior wall closure, and ureteric afferent limb anastomosis were performed. RESULTS The median estimated blood loss was 524 mL, and the mean operative time was 496 min. Patients had a high continence rate, and no high-grade complications were observed. CONCLUSION The NB configuration using the modified VIP method for a hybrid approach is a feasible surgical technique to minimize the movement of robotic forceps. In particular, it may be more useful in Asian individuals with narrow pelvises.
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Affiliation(s)
- Fumitaka Shimizu
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Kosuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Tomoki Kimura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Takeshi Ieda
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
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Bioabsorbable zinc alloys for use in urological surgery. World J Urol 2023; 41:1181-1186. [PMID: 36929408 DOI: 10.1007/s00345-023-04342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Non-absorbable clips are widely used in urologic surgery and they may come in contact with an open urinary tract intraoperatively. As a result, stray clips in the urinary tract and associated intractable infections have been reported. We developed a bioabsorbable metal and evaluated whether it would dissolve if it strayed into the urinary tract. METHODS We prepared four types of alloys mainly comprising zinc (Zn) with small amounts of magnesium (Mg) and strontium (Sr), and the biological effects, degradability, strength, and ductility were investigated. Each alloy was implanted in the bladder of five rats for 4, 8, and 12 weeks. The alloys were removed and evaluated for degradability, stone adhesion, and tissue changes. The Zn-Mg-Sr alloy had degradability and no stone adhesion in the rat experiments, and it was implanted in the bladders of five pigs for 24 weeks. The Mg and Zn levels in the blood were measured, and staple changes were confirmed by cystoscopy. RESULTS Zn-Mg-Sr alloys showed the best degradability of 6.51% at 12 weeks. In pig experiments, the degradation rate was 3.72% at 24 weeks. None of the pigs had changes in the Zn or Mg concentrations in the blood. Overall, the bladder incision was healed and the gross pathology showed wound healing. CONCLUSIONS The Zn-Mg-Sr alloys were safely used in animal experiments. Furthermore, the alloys are easy to process and can be formed into various shapes, such as staples, making them useful in robotic surgery.
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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Mao W, Chen S, Zhang L, Li T, Sun S, Xu B, Zhu W, Zhang G, Zhang L, Wu J, Chen M. Robot-Assisted Laparoscopic Radical Cystectomy and Modified Y-Shaped Ileal Orthotopic Neobladder Reconstruction. Front Surg 2022; 9:889536. [PMID: 35722533 PMCID: PMC9198462 DOI: 10.3389/fsurg.2022.889536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Orthotopic neobladder reconstruction has become the preferred method of urinary diversion after radical cystectomy in major medical centers. We performed modified Y-shaped ileal orthotopic neobladder reconstruction and presented the functional results and postoperative complications of the modified surgery. Methods We included 21 patients with bladder cancer who underwent radical cystectomy at our center between February 2019 and December 2019. All patients underwent robotic-assisted laparoscopic radical cystectomy and lymph node dissection plus modified Y-shaped ileal orthotopic neobladder reconstruction. We collected the demographic and pathological history of the patients, and perioperative and postoperative functional outcomes and postoperative complications were recorded. Results All surgeries were successful and no serious postoperative complications occurred. The mean operative time was 321.43 ± 54.75 min, including 101.67 ± 10.88 min required for neobladder reconstruction. Liquid intake was encouraged about 5 days after surgery, stent and catheter were removed after 13.52 ± 3.28 days, and the patients were discharged 1–2 days after removing the catheter. No ureteral anastomotic and neobladder urethral anastomotic strictures occurred. The volume of the neobladder at 1-year post-surgery was 195.24 ± 16.07 mL and the maximum urinary flow rate was 20.64 ± 2.22 mL/s. Conclusion We describe the robotic-assisted modified Y-shaped ileal orthotopic neobladder reconstruction performed at our center, which requires a simple suture and short neobladder construction time, minimizes the occurrence of anastomotic stenosis, facilitates smooth patient emptying, and is clinically scalable and applicable.
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Affiliation(s)
- Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
- Department of Urology, Nanjing Lishui District People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Lijie Zhang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Tao Li
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Si Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Weidong Zhu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Guangyuan Zhang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Lei Zhang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Correspondence: Ming Chen Jianping Wu Lei Zhang
| | - Jianping Wu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Correspondence: Ming Chen Jianping Wu Lei Zhang
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
- Department of Urology, Nanjing Lishui District People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
- Correspondence: Ming Chen Jianping Wu Lei Zhang
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Robot assisted radical cystectomy with florence robotic intracorporeal neobladder (FloRIN): Functional and urodynamic features compared with a contemporary series of open Vescica Ileale Padovana (VIP). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1854-1861. [DOI: 10.1016/j.ejso.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
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Robot-assisted radical cystectomy: surgical technique, perioperative and oncologic outcomes. Curr Opin Urol 2022; 32:116-122. [PMID: 34798640 DOI: 10.1097/mou.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy is a complex procedure that encompasses surgery involving the urinary, gastrointestinal tracts and the retroperitoneum, with significant morbidity. Robot-assisted radical cystectomy (RARC) has been introduced to improve perioperative outcomes. RECENT FINDINGS It has been shown to provide equivalent oncologic outcomes to open radical cystectomy while providing some benefits in terms of perioperative outcomes. A complete intracorporeal approach utilizing intracorporeal urinary diversion may potentially offer additional benefits. SUMMARY Herein, we describe our technique for RARC and intracorporeal urinary diversion, as well as a review of oncologic and perioperative outcomes.
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Dalimov Z, Iqbal U, Jing Z, Wiklund P, Kaouk J, Kim E, Wijburg C, Wagner AA, Roupret M, Dasgupta P, Gaboardi F, Richstone L, Aboumohamed A, Hussein AA, Guru KA. Intracorporeal Versus Extracorporeal Neobladder After Robot-assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium. Urology 2021; 159:127-132. [PMID: 34710397 DOI: 10.1016/j.urology.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare perioperative and oncologic outcomes of intracorporeal (ICNB) and extracorporeal neobladder (ECNB) following robot assisted radical cystectomy (RARC) from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). METHODS A retrospective review of IRCC database between 2003 and 2020 (3742 patients from 33 institutions across 14 countries) was performed (I-79606). The Cochran-Armitage trend test was used to assess utilization of ICNB over time. Multivariate logistic regression models were fit to evaluate variables associated with receiving ICNB, overall complications, high-grade complications, and readmissions after RARC. Kaplan Meier curves were used to depict recurrence-free, disease-specific, and overall survival. RESULTS Four hundred eleven patients received neobladder, 64% underwent ICNB. ICNB utilization increased significantly over time (P <.01). Patients who received ICNB were readmitted and received neoadjuvant chemotherapy more frequently (36% vs 24%, P = .03, 35% vs 8%, P <.01, respectively). ICNB was associated with older age (OR 1.04, 95% CI 1.01-1.07, P = .001), receipt of neoadjuvant chemotherapy (OR 4.63, 95% CI 2.34-9.18, P <.01), and more recent RARC era (2016-2020) (OR 12.6, 95% CI 5.6-28.4, P <.01). On multivariate analysis, ICNB (OR 5.43, 95% CI 2.34-12.58, P <.01), positive surgical margin (OR 4.88, 95% CI 1.29-18.42, P = .019), longer operative times (OR 1.26, 95% CI 1.00-1.58, P = .048), and institutional annual RARC volume (OR 1.09, 95% CI 1.05-1.12, P <.01) were associated with readmissions. CONCLUSION Utilization of ICNB increased significantly over time. Patients who underwent RARC and ICNB had shorter hospital stays and fewer 30-d reoperations but were readmitted more frequently compared to those who underwent ECNB.
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Affiliation(s)
- Zafardjan Dalimov
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Umar Iqbal
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zhe Jing
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | - Eric Kim
- Washington University St. Louis, St. Louis, MO
| | - Carl Wijburg
- Rijnstate Hospital - Stichting, Arnhem, Gelderland, the Netherlands
| | | | - Morgan Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France
| | | | | | | | - Ahmed Aboumohamed
- Montefiore Medical Center (Albert Einstein College of Medicine), New York, NY
| | - Ahmed A Hussein
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Khurshid A Guru
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
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Robot-Assisted Intracorporeal Orthotopic Ileal Neobladder: Description of the "Shell" Technique. J Clin Med 2021; 10:jcm10163601. [PMID: 34441897 PMCID: PMC8397133 DOI: 10.3390/jcm10163601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (ICNB) remains a very complicated, technically demanding and time-consuming surgical procedure. In the current study we describe our robot-assisted intracorporeal “Shell” neobladder reconstruction. Methods: From January 2017 to December 2019, we performed 30 intracorporeal ileal neobladder “Shell” reconstructions. We prospectively collected demographics and clinical and pathological data and retrospectively analysed perioperative, functional and oncological outcomes. Results: No conversion to open surgery or intraoperative blood transfusion was necessary. The median whole operative time was 493 min (IQR 433–530 min), ranging from 514 min (IQR 502–554 min) recorded during the first ten procedures to 470 min (IQR 442–503 min) of the last ten. The median estimated blood loss was 400 mL (IQR 350–700 mL). The median length of stay was 11 days (IQR 10–17). Both early and late complication rates were 46.7%. The high-grade early complication rate accounted for 20%, while the high-grade late complication rate was 30%. The daytime continence rate registered was 73.3%, while night-time continence rate was 60%. Conclusions: Our results demonstrated “Shell” neobladder reconstruction as a technically feasible procedure, with good functional outcomes in tertiary referral centre. Longer follow-up and larger populations are needed to validate these preliminary results.
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Abozaid M, Tan WS, Khetrapal P, Baker H, Duncan J, Sridhar A, Briggs T, Selim M, Abdallah MM, Elmahdy AA, Elserafy F, Kelly JD. Recovery of health-related quality of life in patients undergoing robot-assisted radical cystectomy with intracorporeal diversion. BJU Int 2021; 129:72-79. [PMID: 34092021 DOI: 10.1111/bju.15505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the health-related quality of life (HRQoL) after robot-assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. PATIENTS AND METHODS Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (EORTC-QLQ-C30) and EORTC-QLQ-Muscle-Invasive Bladder Cancer Module (EORTC-QLQ-BLM30) questionnaires before surgery and had a minimum of 12 months follow-up postoperatively. RESULTS A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC-QLQ-C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90-day Clavien-Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02-0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03-0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC-QLQ-BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06-30.45; P = 0.005) of higher sexual function score at 12 months. CONCLUSION While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway.
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Affiliation(s)
- Mohammed Abozaid
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Wei Shen Tan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Pramit Khetrapal
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hilary Baker
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacqueline Duncan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Tim Briggs
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mohamed Selim
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Alaa Aldin Elmahdy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Fatma Elserafy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - John D Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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12
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Martin AS, Corcoran AT. Contemporary techniques and outcomes of robotic assisted radical cystectomy with intracorporeal urinary diversion. Transl Androl Urol 2021; 10:2216-2232. [PMID: 34159105 PMCID: PMC8185677 DOI: 10.21037/tau.2019.09.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The open approach to radical cystectomy continues to be accompanied by significant morbidity despite enhanced recovery protocols (ERP). Robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) has become an increasingly popular technique for removal of aggressive bladder cancer and subsequent urinary diversion. Randomized clinical trials comparing the robotic and open techniques address the uncertainty surrounding oncological efficacy of the RARC and show that RARC is at least comparable to open radical cystectomy (ORC) in terms of oncologic adequacy and survival. Although RARC with ICUD is a technically challenging procedure, surgeons have noted ergonomic advantages while patients experience less blood loss and quicker time to recovery and to adjuvant chemotherapy (AC), if necessary. Even with these benefits, there is a paucity of data describing outcomes of ICUD. For those surgeons who have switched to ICUD, priority remains standardization of a protocol for the reconstructive component and for a safe transition from extracorporeal urinary diversion (ECUD) to ICUD. Additionally, there is a need for evidence of reduced financial toxicity for the patient, as well as more comprehensive cost-effectiveness analyses. The literature from this review represents 10 years of accumulating data on techniques and outcomes of RARC with ICUD.
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Affiliation(s)
- Ardenne S Martin
- Department of Urology, NYU Winthrop Hospital, Garden City, NY, USA
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13
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14
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Orthotopic Bladder Substitution. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Gu Q, Xia J, Xu A, Zhang T, Wang Z. Robot-assisted radical cystectomy with totally intracorporeal neobladder diversion: perioperative, oncologic, and functional outcomes. Transl Androl Urol 2020; 9:2606-2615. [PMID: 33457233 PMCID: PMC7807315 DOI: 10.21037/tau-20-1075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The use of robot-assisted radical cystectomy (RARC) has increased rapidly in the past decade. However, reports of intracorporeal neobladder diversion remain limited. This article aimed to provide the surgical steps for RARC with totally intracorporeal neobladder diversion and the present perioperative, oncologic, and functional outcomes. Methods Between June 2017 and January 2020, RARC with intracorporeal neobladder diversion was performed in 12 male patients. Perioperative variables, pathologic data, early and late complications, urinary continence, potency, and recurrence-free survival were evaluated as outcome measures. Results The surgery was successful in all cases without open conversion. The median operative time, estimated blood loss, and postoperative hospital stay were 419 min (range, 315–640 min), 400 mL (range, 250–1,200 mL), and 14.5 days (range, 9–25 days), respectively. No positive surgical margins nor lymph nodes were observed. Eleven minor (grades 1 and 2) and one major (grades 3–5) complications were found in the early (0–30 days) period and six minor and one major complications in the late (>30 days) period. The median follow-up time was 13.1 months (range, 5.4–32.0 months), and two patients died due to metastatic disease. At 6 months after surgery, the daytime continence rate was 90.0%, while the nighttime continence rate was 80.0%. Only two patients (16.7%) reported capability of potency. The study was limited by a small sample size and short follow-up. Conclusions RARC with intracorporeal neobladder is a complex procedure but technically feasible with acceptable oncologic and functional outcomes. Studies with long-term follow ups and increased number of cases and randomized trials are indispensable to assess the potential of this technique.
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Affiliation(s)
- Qi Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiadong Xia
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tongtong Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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16
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Intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy: a meta-analysis, cumulative analysis, and systematic review. J Robot Surg 2020; 15:321-333. [PMID: 33222043 DOI: 10.1007/s11701-020-01174-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 12/29/2022]
Abstract
Over the last decade, the increased utilization of robot-assisted radical cystectomy (RARC) in the surgical treatment of muscle-invasive bladder cancer has led to an uptrend in intracorporeal urinary diversions (ICUD). However, the operative results comparing ICUD to extracorporeal urinary diversion (ECUD) have varied widely. We performed a meta-analysis to analyze perioperative outcomes and complications of ICUD compared to ECUD following RARC. This study is registered at International Prospective Register of Systematic Reviews (PROSPERO) CRD42020164074. A systematic literature review was conducted using PubMed, EMBASE, and Cochrane databases in August 2019. A total of six studies comparing ICUD vs ECUD were identified and meta-analysis was conducted on these studies. In addition, a cumulative analysis was also performed on 83 studies that reported perioperative outcomes after RARC and ICUD or ECUD. The Weighed Mean Difference of operative time and blood loss between ICUD and ECUD group was (16; 95% confidence interval - 34 to 66) and (- 86; 95% confidence interval - 124 to - 48), respectively. ICUD and ECUD had comparable early (30-day) and mid-term (30-90-day) complication rate (RR 1.19; 95% confidence interval 0.71-2.0; p = 0.5) and (RR 0.91; 95% confidence interval 0.71-1.15 p = 0.4) respectively. In the 83 studies that were included in the cumulative analysis, the mean operative time for ileal conduit and neobladders by ICUD were 307 and 428 min, respectively, compared to ECUD 428 and 426 min, respectively. ICUD and ECUD have comparable short- and mid-term complication rate. The ICUD group has lower blood loss and lower rate of blood transfusion compared to ECUD.
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17
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Initial Experience with Intracorporeal Laparoscopic Radical Cystectomy and Detaenial Sigmoid Neobladder Reconstruction. Eur Urol 2020; 79:545-551. [PMID: 33203548 DOI: 10.1016/j.eururo.2020.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intracorporeal urinary diversion is considered to be effective in improving intestinal function recovery and reducing the occurrence of early complications after radical cystectomy. Almost all neobladders constructed via intracorporeal laparoscopy have used the ileum. OBJECTIVE To present our intracorporeal detaenial sigmoid neobladder technique that replicates open surgery principles and to present oncological and functional outcomes and complication rates. DESIGN, SETTING, AND PARTICIPANTS This is a case series from a single tertiary referral hospital from September 11, 2018 to April 19, 2019, including 12 selected patients with pathologically confirmed muscle-invasive or refractory non-muscle-invasive bladder cancer. SURGICAL PROCEDURE Laparoscopic radical cystectomy including pelvic lymph-node dissection and intracorporeal detaenial sigmoid neobladder, which is demonstrated in the accompanying video. MEASUREMENTS Demographic, clinical, and pathological data were collected. Perioperative outcomes and 1-yr oncological and functional outcomes are reported. RESULTS AND LIMITATIONS All surgeries were successful without severe complications or conversion to open surgery. The mean operative time (± standard deviation) was 414.6 ± 52.2 min, with 33.8 ± 6.80 min for neobladder construction. Surgical margins and lymph nodes were all negative for metastasis. All patients were encouraged to do ambulation exercise 1 d after surgery, and oral liquid intake was resumed between days 2 and 4. However, because this was a retrospective study in a single centre with very few cases, it is difficult to reach a definitive conclusion. CONCLUSIONS Intracorporeal detaenial sigmoid neobladder is technically feasible with no need for additional medical equipment. Encouraging outcomes were observed during short-term follow-up. This approach could represent another alternative choice for patients undergoing laparoscopic radical cystectomy. Longer-term follow-up data are needed to evaluate oncological and functional outcomes. PATIENT SUMMARY We describe our stepwise technique for intracorporeal detaenial sigmoid neobladder while replicating established open surgery principles. In addition to retaining the advantages of a neobladder, better postoperative recovery is achieved.
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18
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Mistretta FA, Musi G, Collà Ruvolo C, Conti A, Luzzago S, Catellani M, Di Trapani E, Cozzi G, Bianchi R, Ferro M, Cioffi A, Cordima G, Brescia A, Verweij F, Bottero D, Matei DV, Mirone V, De Cobelli O. Robot-Assisted Radical Cystectomy for Nonmetastatic Urothelial Carcinoma of Urinary Bladder: A Comparison Between Intracorporeal Versus Extracorporeal Orthotopic Ileal Neobladder. J Endourol 2020; 35:151-158. [PMID: 32977727 DOI: 10.1089/end.2020.0622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: To compare surgical, oncologic, functional outcomes and complication rate between intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) orthotopic ileal neobladder of robot-assisted radical cystectomy (RARC) in patients with nonmetastatic bladder carcinoma (BC). Materials and Methods: From 2014 to 2019, we prospectively collected and retrospectively analyzed 101 patients with nonmetastatic BC treated with RARC and ortothopic neobladder. Chi-squared test estimated differences in proportions of functional and oncologic outcomes. Multivariable logistic regression models (MLRMs) focused on overall, early (<30 days from discharge), and late complication rate (>30 days from discharge) in ICNB vs ECNB. Results: Of all patients, 57 (56.4%) ICNB and 44 (43.6%) ECNB patients were identified. At least one complication occurred in 75.4% vs 72.7% in ICNB vs ECNB, respectively (p = 0.9). In MLRMs, focusing on complication rate, there was no statistically significant difference between ICNB vs ECNB for overall (p = 0.8), early (p = 0.6), and late complications (p = 0.8). No statistically significant differences were recorded for tumor relapse rate, cancer-specific and other cause mortality. No positive surgical margins were recorded in both groups. Daytime and nighttime continence recovery were 89.4% vs 87.1% (p = 1.0) and 63.8% vs 51.6% (p = 1.0) for ICNB vs ECNB. Potency recovery was 59.1% vs 54.3% (p = 0.5) for ICNB vs ECNB. Conclusions: No statistically significant differences in complication rate (overall, early, or late) were identified, when ICNB and ECNB were compared. Similarly, no statistically significant difference was found in oncologic and functional outcomes.
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Affiliation(s)
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Claudia Collà Ruvolo
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy.,Department of Urology, University of Naples Federico II, Naples, Italy
| | - Andrea Conti
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Michele Catellani
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Giovanni Cordima
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Antonio Brescia
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Fabrizio Verweij
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Danilo Bottero
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Deliu Victor Matei
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy.,Dipartimento di Emato-Oncologia ed Oncologia, University of Milan, Milan, Italy
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19
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Daza J, Jones T, Raven M, Charap A, Sfakianos JP, Mehrazin R, Mohamed N, Wiklund P. Functional Outcomes After Robotic Radical Cystectomy with Intracorporeal Diversion: A Systematic Review. Bladder Cancer 2020. [DOI: 10.3233/blc-190253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Robotic assisted radical cystectomy (RARC) is considered a safe and feasible technique in patients with bladder cancer who are candidates for curative treatment. Intracorporeal urinary diversions (ICUD) represents one step forward into moving to an utterly minimal invasive procedure with the thought that it may improve patients outcomes and time to recovery after the surgical procedure. Overall, RARC has shown to provide similar oncological outcomes as other procedures. The impact of such approach in continence and sexual function of the patients is an important part of an integral health care of this subset of patients. OBJECTIVE: To describe the functional outcomes of RARC with ICUD across different manuscript evaluating this field. METHODS: A systematic literature search related to functional outcomes and diversion technique in RARC with ICUD, was performed on June 2019 using PubMed RESULTS: Out of 22 manuscripts evaluated we included 11 in our analysis. Although the functional outcomes in the studies we have included in this analysis seem to be adequate and consistent, the evidence is poor when comparing RARC with ICUD versus other approaches CONCLUSION: We consider that studies with better designs aiming to elucidate the impact of RARC with ICUD in the quality of life of the patients may improve the quality of the outcomes and would help to draw stronger conclusions
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Affiliation(s)
- Jorge Daza
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Tashzna Jones
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Matthew Raven
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Andrew Charap
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Nihal Mohamed
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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20
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Otaola-Arca H, Seetharam Bhat KR, Patel VR, Moschovas MC, Orvieto M. Totally intracorporeal robot-assisted urinary diversion for bladder cancer (part 2). Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder. Asian J Urol 2020; 8:63-80. [PMID: 33569273 PMCID: PMC7859454 DOI: 10.1016/j.ajur.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023] Open
Abstract
Abstract To review the most used intracorporeal orthotopic ileal neobladder (ICONB) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images. Methods We performed a non-systematic review of the literature with the keywords “bladder cancer”, “urinary diversion”, “radical cystectomy”, and “neobladder”. Results Forty studies were included in the analysis. The most frequent type of ICONB was the modified Studer “U” neobladder (70%) followed by the Hautmann “W” modified neobladder (7.5%), the “Y” neobladder (5%), and the Padua neobladder (5%). The operative time to perform a urinary diversion ranged from 124 to 553 min. The total estimated blood loss ranged from 200 to 900 mL. The rate of positive surgical margins ranged from 0% to 8.1%. Early minor and major complication rates ranged from 0% to 100% and from 0% to 33%, respectively. Late minor and major complication rates ranged from 0% to 70% and from 0% to 25%, respectively. Conclusion The most frequent types of ICONB are Studer “U” neobladder, Hautmann “W” neobladder, “Y” neobladder, and the Padua neobladder. Randomized studies comparing the performance of the different types of ICONB, the performance in an intra or extracorporeal manner, or the performance of an ICONB versus ICIC are lacking in the literature. To this day, there are not sufficient quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images of each technique.
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Affiliation(s)
- Hugo Otaola-Arca
- Department of Urology, Clínica Alemana, Santiago, Chile.,School of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | | | - Vipul R Patel
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marcio Covas Moschovas
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marcelo Orvieto
- School of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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21
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Hosseini A, Mortezavi A, Sjöberg S, Laurin O, Adding C, Collins J, Wiklund PN. Robot-assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes - a single-institution experience. BJU Int 2020; 126:464-471. [PMID: 32403199 DOI: 10.1111/bju.15112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report a single-institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot-assisted laparoscopic radical cystectomy (RARC). PATIENTS AND METHODS A total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30- and 90-day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. The 5-year overall (OS) and cancer-specific survival (CSS) rates were estimated by Kaplan-Meier plots. RESULTS Most of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD ±98) min, with a median (range) estimated blood loss of 300 (50-2200) mL. Most of the men (86%) received a nerve-sparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7-48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow-up was 34 (1-170) months, with 30- and 90-day mortality rates of 0%. Clavien-Dindo Grade III-IV complications occurred in 29 of 158 (18%) patients at 30-days and in eight of 158 (5%) between 30-90 days, resulting into a 90-day overall high-grade complication rate of 23%. The unadjusted estimated 5-years recurrence-free survival, CSS and OS rates were 70%, 72%, and 71%, respectively. CONCLUSION In our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative.
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Affiliation(s)
- Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Ashkan Mortezavi
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Siri Sjöberg
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Oscar Laurin
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Christofer Adding
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Justin Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, UCLH, London, UK
| | - Peter N Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Hussein AA, Elsayed AS, Aldhaam NA, Jing Z, Peabody JO, Wijburg CJ, Wagner A, Canda AE, Khan MS, Scherr D, Schanne F, Maatman TJ, Kim E, Mottrie A, Aboumohamed A, Gaboardi F, Pini G, Kaouk J, Yuh B, Rha KH, Hemal A, Palou Redorta J, Badani K, Saar M, Stockle M, Richstone L, Roupret M, Balbay D, Dasgupta P, Menon M, Guru KA. A comparative propensity score-matched analysis of perioperative outcomes of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. BJU Int 2020; 126:265-272. [PMID: 32306494 DOI: 10.1111/bju.15083] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC). PATIENTS AND METHODS We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90-day high-grade complications (Clavien-Dindo Classification Grade ≥III), and 90-day readmissions after RARC. RESULTS Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high-grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90-day high-grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90-day readmissions. CONCLUSIONS Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high-grade complications.
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Affiliation(s)
| | | | | | - Zhe Jing
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | - Andrew Wagner
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abdullah Erdem Canda
- Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | | | | | - Francis Schanne
- Urological Surgical Associates of Delaware, Wilmington, DE, USA
| | - Thomas J Maatman
- Metro Health Hospital, Michigan State University, East Lansing, MI, USA
| | - Eric Kim
- Washington University, St. Louis, MO, USA
| | | | - Ahmed Aboumohamed
- Montefiore Medical Center, The Albert Einstein College of Medicine, New York, NY, USA
| | | | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bertram Yuh
- City of Hope and Beckman Research Institute, Duarte, CA, USA
| | - Koon-Ho Rha
- Department of Urology, Yonsei University Health System Severance Hospital, Seoul, Korea
| | - Ashok Hemal
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | | | - Ketan Badani
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | | | - Lee Richstone
- The Arthur Smith Institute for Urology, New Hyde Park, NY, USA
| | - Morgan Roupret
- Pitie Salpetriere Academic Hospital, Sorbonne University, Paris, France
| | | | - Prokar Dasgupta
- Guy's Hospital and King's College London School of Medicine, London, UK
| | - Mani Menon
- Henry Ford Health System, Detroit, MI, USA
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Benamran D, Phé V, Drouin SJ, Perrot O, Grégoris A, Parra J, Vaessen C, Seisen T, Rouprêt M. Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review. J Robot Surg 2020; 14:813-820. [DOI: 10.1007/s11701-020-01070-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW We review historical aspects and current status of the emerging approach of robotic urinary diversion (rUD). Established surgical principles of constructing a low-pressure, large-capacity reservoir are described and the open surgical literature succinctly reviewed to establish the gold standard. Incontinent and continent rUD types [ileal conduit, orthotopic neobladder (all varieties), continent cutaneous diversion, cutaneous ureterostomy] and techniques (extra-corporeal, intra-corporeal) are discussed. Outcomes data (intra-operative, perioperative, intermediate-term, long-term), functional outcomes, complications and learning curve are presented. Outcomes data of open versus robotic urinary diversion are examined. Critiques, improvements, and pros-cons of rUD are discussed. RECENT FINDINGS Although the majority of centers performing rUD use the extracorporeal technique, use of intra-corporeal rUD is increasing. Although data are yet limited, intra-corporeal rUD may provide some benefits. For rUD, operative times are higher and complication rates comparable with open urinary diversion. SUMMARY The entire range of urinary diversion surgery has now been replicated robotically. At this writing, extracorporeal urinary diversion techniques still predominate following robotic cystectomy. However, all rUD options can now be performed intra-corporeally with success. As experience increases, the field of robotic urinary diversion is poised to grow.
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Zhou X, Zheng J, He P, Zhang J, Wang C, Zheng J, Li X, Lang L, Zhou Z, Chen Z. Refinement Surgical Technique, and Perioperative and Functional Outcomes in Patients With Robotic Intracorporeal Hautmann Orthotopic Neobladder. Urology 2020; 138:45-51. [PMID: 32006548 DOI: 10.1016/j.urology.2020.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/01/2020] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To illustrate our refinement technique for robotic intracorporeal orthotopic Hautmann neobladder with adherence to open surgical principles and evaluate perioperative and functional outcomes. PATIENTS AND METHODS Robot-assisted radical cystectomy with intracorporeal Hautmann orthotopic neobladder was performed by the same surgeon in 40 patients with bladder cancer from November 2017 to March 2019. Baseline demographics, pathologic data, 90-day complications, and functional outcomes at both 6 and 12 months were evaluated with questionnaire and urodynamic analysis. RESULTS Median follow-up was 14 months (range 4-20). Median operative time was 320 (230-500) minutes, and the estimated blood loss was 300 (100-2000) mL. No conversion to the open technique was reported. The overall 90-day complication rate was 45%, and the high-grade complication rate was only 10%. The daytime satisfactory continence rate was 90% at both 6 months (30 patients) and 12 months (20 patients), while the night-time satisfactory continence rate was 76.7% and 80.0% at 6 months and 12 months, respectively. One patient underwent clean intermittent catheterization. The cohort had minimal postvoid residual volume, normal compliance, and a mean capacity of 328.7 cm3 (range 170-500) at 6 months postoperatively. CONCLUSION Our preliminary data indicate that robotic intracorporeal Hautmann neobladder configuration is a feasible surgical technique and can achieve a low pressure and sufficient capacity for satisfactory early voiding patterns. Refinement of the stepwise process can effectively decrease the time of the operation. Long-term functional and oncological outcomes remain to be evaluated with longer follow-up and more cases.
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Affiliation(s)
- Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Ji Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jingqi Zhang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Cong Wang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jun Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Lang Lang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China.
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Cacciamani GE, De Marco V, Sebben M, Rizzetto R, Cerruto MA, Porcaro AB, Gill IS, Artibani W. Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles. Eur Urol 2019; 76:381-390. [DOI: 10.1016/j.eururo.2018.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
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Tyritzis SI, Gaya JM, Wallestedt-Lantz A, Pini G, Everaerts W, de Naeyer G, Palou J, Kelly J, Wiklund NP. Current role of robotic bladder cancer surgery. MINERVA UROL NEFROL 2019; 71:301-308. [PMID: 31086134 DOI: 10.23736/s0393-2249.19.03435-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC. EVIDENCE ACQUISITION A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines. EVIDENCE SYNTHESIS RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique. CONCLUSIONS As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.
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Affiliation(s)
- Stavros I Tyritzis
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden - .,Department of Urology, HYGEIA Hospital, Athens, Greece -
| | - Josep M Gaya
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Wallestedt-Lantz
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden
| | - Giovannalberto Pini
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Wouter Everaerts
- Department of Urology, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Joan Palou
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Nils P Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden.,ICAHN School of Medicine, Mount Sinai Hospital, New York, NY, USA
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Robotic Surgery as Applied to Functional and Reconstructive Urology. Eur Urol Focus 2019; 5:322-328. [DOI: 10.1016/j.euf.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
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29
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Hosseini A, Ebbing J, Collins J. Clinical outcomes of robot-assisted radical cystectomy and continent urinary diversion. Scand J Urol 2019; 53:81-88. [DOI: 10.1080/21681805.2019.1598486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institut, Stockholm, Sweden
| | - Jan Ebbing
- Urology, Universitat Basel Medizinische Fakultat, Basel, Switzerland
| | - Justin Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institut, Stockholm, Sweden
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30
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Contemporary techniques and outcomes of robotic cystectomy and intracorporeal urinary diversions. Curr Opin Urol 2019; 28:115-122. [PMID: 29256905 DOI: 10.1097/mou.0000000000000472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is being increasingly performed worldwide. This review summarizes recent technical developments and outcome data for RARC with ICUD. RECENT FINDINGS With the recent description of intracorporeal continent cutaneous diversion, all classes of urinary diversion can presently be performed totally intracorporeally. The summary of our seven cases of intracorporeal continent cutaneous diversion in this article brings the number of reported cases in the literature to 17. Additional recent advancements in ICUD focus on novel technical descriptions and outcome data. Several intracorporeal orthotopic ileal neobladder techniques have been described with intermediate perioperative outcomes. There is some rationale for reduced overall, wound, gastrointestinal and genitourinary complications with ICUD. SUMMARY RARC with intracorporeal diversion is a feasible option for patients with bladder cancer. Prospective and randomized outcome data are needed to better characterize the benefit of ICUD in patients following radical cystectomy.
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Koie T, Ohyama C, Makiyama K, Shimazui T, Miyagawa T, Mizutani K, Tsuchiya T, Kato T, Nakane K. Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer. Int J Urol 2019; 26:334-340. [PMID: 30690817 PMCID: PMC6850512 DOI: 10.1111/iju.13900] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/09/2018] [Indexed: 01/06/2023]
Abstract
Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.
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Affiliation(s)
- Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Clinical Education and Training Center, Faculty of Medicine, University of Tsukuba, Kasama, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Depatment of Urology, Jichi Medical University Saitama Medical Center, Urawa, Saitama, Japan
| | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Taku Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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[INITIAL EXPERIENCE WITH ROBOT-ASSISTED RADICAL CYSTECTOMY AND INTRACORPOREAL URINARY DIVERSION ~COMPARISON WITH THE CONVENTIONAL METHOD~]. Nihon Hinyokika Gakkai Zasshi 2019; 110:80-85. [PMID: 32307387 DOI: 10.5980/jpnjurol.110.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objectives) While robot assisted radical cystectomy (RARC) has been associated with improved perioperative outcomes such as blood loss, hospital stay, and improved convalescence, much of the criticism has been attributable to the longer operative time. Opinions are divided regarding whether intracorporeal urinary diversion (ICUD) or extracorporeal urinary diversion (ECUD) should be performed. The aim of this study is to evaluate the utility of RARC and ICUD by comparing with the conventional method. (Patients and methods) From December 2014 to July 2018, 14 patients underwent laparoscopic radical cystectomy (LRC) and 16 patients underwent RARC at our institution. Among the 30 patients, 23 underwent ileal conduit or orthotopic bladder; these patients were divided into two groups: an ICUD patient group (n=10) and an ECUD patient group (n=13). Treatment outcomes were compared between groups. (Results) Compared to patients who underwent LRC those treated with RARC had older (75 vs. 67, P=0.031). There was a trend of high-risk cases (American Society of Anesthesiologists' physical status classification ≥3) more frequently (31.3% vs. 7.1%, P=0.176). Patient treated with RARC had less blood loss (150 vs. 544 ml, P=0.003). There was no significant difference in the intra- and postoperative complication rates (12.5% vs. 21.4%, P=0.642). Compared to patients who underwent ECUD, those treated with ICUD included a longer operative time for urinary diversion (222 vs. 181 minutes, P=0.007) but less maximal incision length without perineal incision (3.0 vs. 6.0 cm, P=0.002). (Conclusions) Our data suggests that RARC is a safe procedure with potential advantages in terms of reduced blood loss. ICUD has longer operative time but is a procedure with excellent cosmetic results.
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Tan WS, Kelly JD. Is experience with extracorporeal urinary diversion following robotic assisted radical cystectomy necessary before transitioning to intracorporeal urinary diversion? Transl Androl Urol 2018; 7:S735-S737. [PMID: 30687611 PMCID: PMC6323277 DOI: 10.21037/tau.2018.08.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
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Koie T, Ohyama C, Yoneyama T, Nagasaka H, Yamamoto H, Imai A, Hatakeyama S, Hashimoto Y. Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes. Int J Med Robot 2018; 14:e1955. [PMID: 30141263 PMCID: PMC6282822 DOI: 10.1002/rcs.1955] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/20/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study compared the surgical and urinary functional outcomes in patients with muscle-invasive bladder cancer (MIBC) who underwent robot-assisted radical cystectomy (RARC) followed by intracorporeal ileal neobladder reconstruction (ICNB) to those in patients who underwent minimum incision endoscopic radical cystectomy (MIE-RC) followed by extracorporeal ileal neobladder reconstruction (ECNB). MATERIALS AND METHODS This study reviewed the clinical records of 153 consecutive MIBC patients who underwent neoadjuvant chemotherapy followed by radical cystectomy and ileal neobladder reconstruction. RESULTS The operative time in the ICNB group was significantly longer than that in the ECNB group. The median estimated blood loss was significantly less in the ICNB group than in the ECNB group. The neobladder capacity gradually increased in both groups. The maximum neobladder pressure and urethral closure pressure gradually improved in both groups. CONCLUSION Our initial experience with ICNB was favourable, with acceptable surgical and urinary functional outcomes.
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Affiliation(s)
- Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Nagasaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Catto JWF, Khetrapal P, Ambler G, Sarpong R, Khan MS, Tan M, Feber A, Dixon S, Goodwin L, Williams NR, McGrath J, Rowe E, Koupparis A, Brew-Graves C, Kelly JD. Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study. BMJ Open 2018; 8:e020500. [PMID: 30093510 PMCID: PMC6089318 DOI: 10.1136/bmjopen-2017-020500] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Bladder cancer (BC) is a common malignancy and one of the most expensive to manage. Radical cystectomy (RC) with pelvic lymphadenectomy is a gold standard treatment for high-risk BC. Reductions in morbidity and mortality from RC may be achieved through robot-assisted RC (RARC). Prospective comparisons between open RC (ORC) and RARC have been limited by sample size, use of extracorporeal reconstruction and use of outcomes important for ORC. Conversely, while RARC is gaining in popularity, there is little evidence to suggest it is superior to ORC. We are undertaking a prospective randomised controlled trial (RCT) to compare RARC with intracorporeal reconstruction (iRARC) and ORC using multimodal outcomes to explore qualitative and quantitative recovery after surgery. METHODS AND ANALYSIS: iROC is a multicentre prospective RCT in English National Health Service (NHS) cancer centres. We will randomise 320 patients undergoing RC to either iRARC or ORC. Treatment allocation will occur after trial entry and consent. The primary outcome is days alive and out of hospital within the first 90 days from surgery. Secondary outcomes will measure functional recovery (activity trackers, chair-to-stand tests and health related quality of life (HRQOL) questionnaires), morbidity (complications and readmissions), cost-effectiveness (using EuroQol-5 Domain-5 levels (EQ-5D-5L) and unit costs) and surgeon fatigue. Patients will be analysed according to intention to treat. The primary outcome will be transformed and analysed using regression. All statistical assumptions will be investigated. Secondary outcomes will be analysed using appropriate regression methods. An internal feasibility study of the first 30 patients will evaluate recruitment rates, acceptance of randomised treatment choice, compliance outcome collection and to revise our sample size. ETHICS AND DISSEMINATION The study has ethical approval (REC reference 16/NE/0418). Findings will be made available to patients, clinicians, funders and the NHS through peer-reviewed publications, social media and patient support groups. TRIAL REGISTRATION NUMBERS ISRCTN13680280 and NCT03049410.
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Affiliation(s)
- James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Rachael Sarpong
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Melanie Tan
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Simon Dixon
- Health Economics and Decision Science, NIHR Research Design Service Yorkshire and the Humber, University of Sheffield, Sheffield, UK
| | - Louise Goodwin
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | | | - Chris Brew-Graves
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Division of Surgery and Interventional Science, University College London, London, UK
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Safe transition from extracorporeal to intracorporeal urinary diversion following robot-assisted cystectomy: a recipe for reducing operative time, blood loss and complication rates. World J Urol 2018; 37:367-372. [PMID: 29934671 PMCID: PMC6373357 DOI: 10.1007/s00345-018-2386-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose We report the perioperative outcomes and complications after transition from extracorporeal urinary diversion (ECUD) to intracorporeal urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC). Methods Analysis of data from a prospectively maintained institutional review board-approved database of 180 patients treated with cystectomy at our institution from April 2015 to October 2017 was performed. 127 patients underwent RARC and received an ileal conduit. Only five patients received a neobladder after RARC and were excluded from analysis. Results 68 patients had extracorporeal and 59 intracorporeal ileal conduit after RARC. There were no significant differences in patient demographics and oncological characteristics between the two groups. Of note, intracorporeal ileal conduit was associated with significantly reduced median total operative times (330 vs 375 min, p = 0.019), reduced median estimated blood loss (300 vs 425 ml, p < 0.035) and lower 30-day overall complication rates (48.4 vs 71.4%, p = 0.008) when compared to extracorporeal diversion. However, the median length of stay, 30–90-day complication rates, mortality rates and ureteroileal anastomotic stricture rates were similar in both groups. The median operative time for RARC and intracorporeal ileal conduit was significantly shorter in the second cohort of 29 cases compared to the first 30 cases (300 vs 360 min, p = 0.004). Other outcomes were similar in both cohorts. Conclusion In our experience, transition from extracorporeal to intracorporeal diversion after RARC is safe, technically feasible and benefits from shorter operative times, reduced estimated blood loss, and lower 30-day overall complication rates.
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Abstract
Robot-assistance is being increasingly used for radical cystectomy (RC). Fifteen years of surgical evolution might be considered a short period for a radical procedure to be established as the treatment of choice, but robot assisted radical cystectomy (RARC) is showing promising results when compared with the current gold standard, open RC (ORC). In this review, we describe the current status of RARC and continue the discussion on the on-going RARC versus ORC debate.
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Affiliation(s)
- Stavros Ioannis Tyritzis
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
| | - Justin W Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
| | - Nils Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
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Hussein AA, May PR, Jing Z, Ahmed YE, Wijburg CJ, Canda AE, Dasgupta P, Shamim Khan M, Menon M, Peabody JO, Hosseini A, Kelly J, Mottrie A, Kaouk J, Hemal A, Wiklund P, Guru KA. Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Urol 2017; 199:1302-1311. [PMID: 29275112 DOI: 10.1016/j.juro.2017.12.045] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. MATERIALS AND METHODS We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. RESULTS In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01-1.03, p <0.002), year of robot-assisted radical cystectomy (2013-2016 OR 68, 95% CI 44-105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38-2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). CONCLUSIONS The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.
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Affiliation(s)
- Ahmed A Hussein
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Paul R May
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Zhe Jing
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Youssef E Ahmed
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Carl J Wijburg
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Abdulla Erdem Canda
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Prokar Dasgupta
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Mohammad Shamim Khan
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Mani Menon
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - James O Peabody
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Abolfazl Hosseini
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - John Kelly
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Alexandre Mottrie
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Jihad Kaouk
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Ashok Hemal
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Peter Wiklund
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
| | - Khurshid A Guru
- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.
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- Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina
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Tan WS, Tan MY, Lamb BW, Sridhar A, Mohammed A, Baker H, Nathan S, Briggs T, Tan M, Kelly JD. Intracorporeal robot-assisted radical cystectomy, together with an enhanced recovery programme, improves postoperative outcomes by aggregating marginal gains. BJU Int 2017; 121:632-639. [PMID: 29124853 DOI: 10.1111/bju.14073] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the cumulative effect of an enhanced recovery after surgery (ERAS) pathway and minimally invasive robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) in comparison with open radical cystectomy (ORC) on length of hospital stay (LOS) and peri-operative outcomes. MATERIALS AND METHODS Between February 2009 and October 2017, 304 radical cystectomy cases were performed at a single institution (ORC, n = 54; robot-assisted radical cystectomy [RARC], n = 250). Data were prospectively collected. We identified 45 consecutive ORC cases performed without ERAS before the commencement of the RARC programme (Cohort A), 50 consecutive iRARC cases performed without ERAS (Cohort B) and 40 iRARC cases with ERAS (Cohort C). The primary outcome measure was LOS, while secondary outcome measures included peri-operative 90-day complications and readmission rate. Complications were accessed using the Clavien-Dindo system. RESULTS Patients in all cohorts were evenly matched with regard to age, sex, body mass index, neoadjuvant treatment, tumour stage, lymph node yield, previous pelvic radiotherapy and surgery, peri-operative anaemia, as well as physiological state. Patients who underwent iRARC with ERAS had a significantly higher American Society of Anesthesiologists score (III-IV) and were more likely to receive neobladder reconstruction. The median (interquartile range) LOS was shorter in the iRARC with ERAS group (7 [6-10]) days than in the iRARC without ERAS group (11 [8-15]) days and the ORC group (17 [14-21] days). In a propensity score-matched cohort of patients who underwent iRARC, patients who followed the ERAS pathway had significantly lower 90-day readmission rates. Additionally, implementing ERAS in an iRARC cohort resulted in a significantly lower 90-day all (P < 0.001) and gastrointestinal-related complications (P = 0.001). The ERAS pathway and younger patients were independently associated with an LOS of ≤10 days on multinomial logistic regression. CONCLUSION A comprehensive ERAS programme can significantly reduce LOS in patients undergoing iRARC without increasing 90-day readmission rates. An ERAS programme can augment the benefits of iRARC in improving peri-operative outcomes. In studies comparing ORC and RARC, the presence or absence of an ERAS programme will be a confounding factor and only level 1 evidence can be interpreted reliably.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Mae-Yen Tan
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Benjamin W Lamb
- Department of Urology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Anna Mohammed
- Department of Urology, University College London Hospital, London, UK
| | - Hilary Baker
- Department of Urology, University College London Hospital, London, UK
| | - Senthil Nathan
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Timothy Briggs
- Department of Urology, University College London Hospital, London, UK
| | - Melanie Tan
- Department of Urology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Anaesthesia and Peri-operative Medicine, University College London, London, UK
| | - John D Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
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Tyritzis SI, Wiklund NP. Is the open cystectomy era over? An update on the available evidence. Int J Urol 2017; 25:187-195. [PMID: 29178344 DOI: 10.1111/iju.13497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/18/2017] [Indexed: 12/24/2022]
Abstract
In 2018, robot-assisted radical cystectomy will enter its 15th year. In an era where an effort is being made to standardize complication reporting and videos of the procedure are readily available, it is inevitable and justified that like everything novel, robot-assisted radical cystectomy should be scrutinized against the gold standard, open radical cystectomy. The present comparison is focused on several parameters: oncological, functional and complication outcomes, and direct and indirect costs. Meta-analysis and prospective randomized trials comparing robot-assisted radical cystectomy versus open radical cystectomy have been published, showing an oncological equivalence and in some cases an advantage of robot-assisted radical cystectomy in terms of postoperative morbidity. In the present review, we attempt to update the available knowledge on this debate and discuss the limitations of the current evidence that prevent us from drawing safe conclusions.
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Affiliation(s)
- Stavros I Tyritzis
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
| | - N Peter Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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A comprehensive guide to perioperative management and operative technique for robotic cystectomy with intracorporeal urinary diversion. Urologia 2017; 84:71-78. [PMID: 28256704 DOI: 10.5301/uj.5000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/20/2022]
Abstract
Robotic-assisted radical cystectomy (RARC) represents an evolution of open radical cystectomy (ORC) with the aim of reducing patient morbidity and improving return to normal function, whilst maintaining oncological equivalence. RARC is gaining popularity, especially in high-volume centres, although there remains a lack of level 1 evidence to demonstrate any superiority of RARC over ORC. All previously reported studies that randomised ORC and RARC have utilised a technique for RARC requiring a conversion to open surgery for urinary diversion. Conversion to open surgery invariably masks the benefits of a truly minimally invasive approach. Moreover, such studies tend to report a small sample size, likely reflecting early surgical experience that may contribute to the lack of observed benefit. Nonetheless, it is established that short-term oncological outcomes following RARC are comparable to those after ORC. It is likely that the benefits of RARC are only observed in cases wherein intracorporeal urinary diversion (iRARC) is performed by a surgical team with high volume experience, which will minimise morbidity and maximise early return to normal function. In this review, we will discuss a holistic approach to iRARC, including patient selection, perioperative optimisation, the surgical technique for iRARC with urinary diversion reconstruction, the use of enhanced recovery protocol, oncological outcomes and perioperative complications.
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Hussein AA, Ahmed YE, Kozlowski JD, May PR, Nyquist J, Sexton S, Curtin L, Peabody JO, Abol-Enein H, Guru KA. Robot-assisted approach to 'W'-configuration urinary diversion: a step-by-step technique. BJU Int 2017; 120:152-157. [PMID: 28220593 DOI: 10.1111/bju.13824] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a detailed step-by-step approach of our technique for robot-assisted intracorporeal 'W'-configuration orthotopic ileal neobladder. PATIENTS AND METHODS Five patients underwent robot-assisted radical cystectomy (RARC), extended pelvic lymph node dissection and intracorporeal neobladder (ICNB). ICNB was divided into six key steps to facilitate and enable a detailed analysis and auditing of the technique. No conversion to open surgery was required. Timing for each step was noted. All patients had at least 3 months of follow-up. RESULTS The mean age was 57 years. The mean overall console and diversion times were 357 and 193 min, respectively. None of the patients had any evidence of residual disease after RARC. Four of the five patients had complications; three developed fevers due to urinary tract infections (one required readmission), and one developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularisation and construction of the posterior plate were consistently the longest among the key steps (average 46 min, 13% of the overall operative time), followed by uretero-ileal anastomosis (37 min, 10%), neobladder-urethral anastomosis (23 min, 6%), and identification and fixation of the bowel (26 min, 7%). CONCLUSION We described our step-by-step technique and initial perioperative outcomes of our first five ICNBs with 'W' configuration.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Urology, Cairo University, Cairo, Egypt
| | - Youssef E Ahmed
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Paul R May
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - John Nyquist
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sandra Sexton
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Leslie Curtin
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Hassan Abol-Enein
- Department of Urology and Nephrology, Mansoura University, Mansoura, Egypt
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
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Tan WS, Lamb BW, Khetrapal P, Tan MY, Tan MEL, Sridhar A, Cervi E, Rodney S, Busuttil G, Nathan S, Hines J, Shaw G, Mohammed A, Baker H, Briggs TP, Klein A, Richards T, Kelly JD. Blood Transfusion Requirement and Not Preoperative Anemia Are Associated with Perioperative Complications Following Intracorporeal Robot-Assisted Radical Cystectomy. J Endourol 2017; 31:141-148. [DOI: 10.1089/end.2016.0730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Benjamin W. Lamb
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Mae-Yen Tan
- School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Melanie EL Tan
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Elizabeth Cervi
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom
| | - Simon Rodney
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Gerald Busuttil
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Senthil Nathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | - John Hines
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Anna Mohammed
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Hilary Baker
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Timothy P. Briggs
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Andrew Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Papworth, United Kingdom
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - John D. Kelly
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
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Tan WP, Whelan P, Deane LA. Intentional Omission of Ureteral Stents During Robotic-assisted Intracorporeal Ureteroenteric Anastomosis: Is It Safe and Feasible? Urology 2017; 102:116-120. [PMID: 28111222 DOI: 10.1016/j.urology.2017.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/29/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the surgical technique we used to perform a stentless intracorporeal ureteroenteric anastomosis and to determine the outcomes in this initial series. METHODS We performed a retrospective review of a prospective database of all patients undergoing robotic-assisted intracorporeal urinary diversion with stentless ureteroenteric anastomosis between March 2014 and July 2016. Diversions were performed at the time of either robotic-assisted laparoscopic cystectomy for bladder cancer or urinary diversion for other indications. RESULTS A total of 10 patients underwent implantation of 20 ureters into the intestine via a robotic-assisted approach with intentional omission of stents. Median body mass index was 29.57 (first quartile 23.68, third quartile 34.69). Median American Society of Anesthesiologists score was 3 (range 2-3). Seven patients had intracorporeal ileal conduit reconstruction and 3 patients had an intracorporeal neobladder creation. There were no patients who developed a stricture of the ureter nor did any patient develop a leak at the ureteroenteric anastomosis. All patients had normal serum creatinine at least 4 weeks after surgery, and all patients had follow-up computed tomography of the kidneys, which were normal. The median follow-up was 8 months (first quartile = 3 months, third quartile = 17 months). CONCLUSION Robotic intracorporeal urinary diversion with intentional omission of ureteral stents is a safe and feasible option when establishing continuity of the genitourinary and gastrointestinal tracts.
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Affiliation(s)
- Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL.
| | - Patrick Whelan
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Leslie A Deane
- Department of Urology, Rush University Medical Center, Chicago, IL
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Whelan P, Tan WP, Papagiannopoulos D, Omotosho P, Deane L. Robotic assisted laparoscopic radical cystectomy with stentless intracorporeal modified Ves.Pa neobladder: early experience. J Robot Surg 2017; 11:423-431. [PMID: 28070738 DOI: 10.1007/s11701-017-0673-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
This study aimed at demonstrating the feasibility of robotic assisted laparoscopic radical cystectomy with pure intracorporeal modified Ves.Pa neobladder with stentless ureteroileal anastomosis. Pure intracorporeal robotic assisted laparoscopic technique has been recently developed with a select number of high-volume centers utilizing various operative and neobladder techniques. We reviewed the patient characteristics, operative details and perioperative courses in the two patients who have undergone robotic assisted laparoscopic radical cystectomy with pure intracorporeal modified Ves.Pa neobladder and one who has undergone the Hautmann W neobladder. These results were compared to other contemporary robotic neobladder series. We demonstrate technical success with similar operative and perioperative results with the modified Ves.Pa neobladder. The robotic pure intracorporeal modified Ves.Pa neobladder is a technically feasible operation and may be easier to perform compared to other neobladders. Initial experience suggests operative time and perioperative outcomes are similar to other robotic techniques.
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Affiliation(s)
| | - Wei Phin Tan
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Leslie Deane
- Rush University Medical Center, Chicago, IL, USA
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Chopra S, de Castro Abreu AL, Berger AK, Sehgal S, Gill I, Aron M, Desai MM. Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique. BJU Int 2016; 119:185-191. [PMID: 27474790 DOI: 10.1111/bju.13611] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe our, step-by-step, technique for robotic intracorporeal neobladder formation. PATIENTS AND METHODS The main surgical steps to forming the intracorporeal orthotopic ileal neobladder are: isolation of 65 cm of small bowel; small bowel anastomosis; bowel detubularisation; suture of the posterior wall of the neobladder; neobladder-urethral anastomosis and cross folding of the pouch; and uretero-enteral anastomosis. Improvements have been made to these steps to enhance time efficiency without compromising neobladder configuration. RESULTS Our technical improvements have resulted in an improvement in operative time from 450 to 360 min. CONCLUSION We describe an updated step-by-step technique of robot-assisted intracorporeal orthotopic ileal neobladder formation.
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Affiliation(s)
- Sameer Chopra
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis de Castro Abreu
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre K Berger
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shuchi Sehgal
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mihir M Desai
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: A prospective cohort study. Urol Oncol 2016; 34:417.e17-23. [DOI: 10.1016/j.urolonc.2016.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/09/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
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Tan WS, Lamb BW, Tan MY, Ahmad I, Sridhar A, Nathan S, Hines J, Shaw G, Briggs TP, Kelly JD. In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion. Eur Urol Focus 2016; 3:273-279. [PMID: 28753745 DOI: 10.1016/j.euf.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/16/2016] [Accepted: 06/02/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) is an attractive option to open cystectomy, but the benefit in terms of improved outcomes is not established. OBJECTIVE To evaluate the early postoperative morbidity and mortality of patients undergoing iRARC and conduct a critical analysis of complications using standardised reporting criteria as stratified according to urinary diversion. DESIGN, SETTING, AND PARTICIPANTS A total of 134 patients underwent iRARC for bladder cancer at a single centre between June 2011 and July 2015. INTERVENTION Radical cystectomy with iRARC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient demographics, pathologic data, and 90-d perioperative mortality and complications were recorded. Complications were reported according to the Clavien-Dindo (CD) classification and stratified according to urinary diversion type and either surgical or medical complications. The chi-square test and t test were used for categorical and continuous variables respectively. Multivariable logistic regression was performed on variables with significance in univariate analysis. RESULTS AND LIMITATIONS The 90-d all complication rate following ileal conduit and continent diversion was 68% and 82.4%, and major complications were 21.0% and 20.6% respectively. The 90-d mortality was 3% and 2.9% for ileal conduit and continent diversion patients, respectively. On multivariate analysis, the blood transfusion requirement was independently associated with major complications (p=0.002) and all 30-d (p=0.002) and 90-d (p=0.012) major complications. Male patients were associated with 90-d major complications (p=0.015). Critical analysis identified that surgical complications were responsible for 39.4% of all 90-d major complications. The incidence of surgical complications did not decline with increasing number of iRARC cases performed (p=0.742, r=0.31). Limitations of this study include its retrospective nature, limited sample size, and limited multivariate analysis due to the low number of major complications events. CONCLUSIONS Although complications following iRARC are common, most are low grade. A critical analysis identified surgical complications as a cause of major complications. Addressing this issue could have a significant impact on lowering the morbidity associated with iRARC. PATIENT SUMMARY We looked at the surgical outcomes in bladder cancer patients treated with minimally invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from a different centre even in a randomised trial setting.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
| | - Benjamin W Lamb
- Department of Urology, University College London Hospital, London, UK
| | - Mae-Yen Tan
- Uro-oncology Group, Cancer Research UK, Beatson Institute, Glasgow University, Glasgow, UK
| | - Imran Ahmad
- Department of Urology, University College London Hospital, London, UK; Uro-oncology Group, Cancer Research UK, Beatson Institute, Glasgow University, Glasgow, UK
| | - Ashwin Sridhar
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Senthil Nathan
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - John Hines
- Department of Urology, University College London Hospital, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Timothy P Briggs
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
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Tan WS, Lamb BW, Kelly JD. Evolution of the neobladder: A critical review of open and intracorporeal neobladder reconstruction techniques. Scand J Urol 2016; 50:95-103. [DOI: 10.3109/21681805.2016.1141318] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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