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Fu H, Hillman E, Talluri S, Liang L, Mohammed S, Messer J. Comparison of the perioperative outcomes of using the Firefly system with indocyanine green during robotic-assisted cystectomy with urinary diversion. Int J Urol 2024; 31:646-652. [PMID: 38426591 DOI: 10.1111/iju.15438] [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: 10/23/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Use of indocyanine green (ICG) with near-infrared fluorescence (NIRF) has been demonstrated to be an effective tool for intraoperative assessment of bowel and ureteric vascularity. This study aimed to evaluate the impact of ICG on postsurgical outcomes such as anastomotic bowel leak and uretero-enteric stricture formation during robot-assisted cystectomy (RAC) and intracorporeal urinary diversion (ICUD). METHODS We identified 238 patients who underwent RAC at the University of Louisville between September 2012 and August 2021. Patients were divided into two groups based on the utilization of ICG. Demographic, perioperative outcomes, and rate of anastomotic bowel leak were compared. RESULTS In total, 138 patients were in the ICG group and 100 patients were in the non-ICG group. More intracorporeal urinary diversions and more simple cystectomies were observed in the ICG group (p < 0.001 and p = 0.015, respectively). The ICG group patients initiated an oral diet sooner than the control group (4.9 vs. 7.1 days, p < 0.001). The mean length of stay of the ICG group was shorter than the non-ICG group (8.3 vs. 12.8 days, p < 0.001). The rate of postoperative ileus was not significantly different between cohorts. No patients in the ICG group experienced a bowel leak compared with five patients in the non-ICG group (p = 0.008). CONCLUSIONS In our study, the use of ICG for intraoperative assessment of bowel and ureteric vascularity was associated with earlier bowel recovery and a shorter length of stay. It was also significantly correlated with a lower rate of anastomotic bowel leak.
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Affiliation(s)
- Hangcheng Fu
- Urology Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Emily Hillman
- Urology Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Sriharsha Talluri
- Urology Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Lifan Liang
- Medicine Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Said Mohammed
- Urology Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jamie Messer
- Urology Department of University of Louisville School of Medicine, Louisville, Kentucky, USA
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Cochetti G, Paladini A, Del Zingaro M, Ciarletti S, Pastore F, Massa G, De Angelis L, Mearini E. Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications. Front Surg 2023; 10:1157684. [PMID: 37383384 PMCID: PMC10293791 DOI: 10.3389/fsurg.2023.1157684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler. Material and methods From January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien-Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications. Results Overall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones. Conclusion RARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.
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Peteinaris A, Kallidonis P, Tsaturyan A, Pagonis K, Faitatziadis S, Gkeka K, Vagionis A, Natsos A, Obaidat M, Anaplioti E, Tatanis V, Vrettos T, Liatsikos E. The feasibility of robot-assisted radical cystectomy: an experimental study. World J Urol 2023; 41:477-482. [PMID: 36577927 DOI: 10.1007/s00345-022-04266-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To investigate the feasibility of the avatera system for performing robot-assisted radical cystectomy (RARC) followed by intracorporeal reconstruction of ileal neobladder. METHODS Six anesthetized female pigs were used to perform RARC and formation of the intracorporeal orthotopic ileal neobladder. Three surgeons with different level of expertise in the use of robotic systems performed RARC after a short instructional lecture and a 2-h hands-on training. The urinary diversion phase was performed only by the experienced surgeon. The successful completion of the procedure, operative time for demolitive and reconstructive phases, intraoperative blood loss and malfunction of the robotic system were evaluated. RESULTS An improvement of the operative time was observed for each surgeon. The experienced surgeon, the fellow and the resident improved their time by 11, 15, and 22 min, respectively, between the first and the second RARC performed. The most significant time difference was demonstrated by the resident, who had no previous experience in using robotic systems. The time difference between the first and the last orthotopic ileal neobladder creation for the experienced surgeon was 51 min. CONCLUSION The feasibility of avatera system for performing complex surgical procedure such as RARC with intracorporeal neobladder formation was demonstrated by this experimental study. No major bleeding or severe malfunctions were observed during the procedures. Significant improvement in operative time was demonstrated with the increasing experience from 1st to 6th case.
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Affiliation(s)
- Angelis Peteinaris
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Kristiana Gkeka
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Mohammed Obaidat
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Eirini Anaplioti
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria.
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