Robotic intracorporeal urinary diversion

Technical details to improve time efficiency

Mihir M. Desai, Andre Luis Castro De Abreu, Alvin C. Goh, Adrian Fairey, Andre Berger, Scott Leslie, Hui Wen Xie, Karanvir S. Gill, Gus Miranda, Monish Aron, Rene J. Sotelo, Yinghao Sun, Zhang Xu, Inderbir Singh Gill

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. Patients and Methods: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded. Results: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow-up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively. Conclusions: Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.

Original languageEnglish (US)
Pages (from-to)1320-1327
Number of pages8
JournalJournal of Endourology
Volume28
Issue number11
DOIs
StatePublished - 2014
Externally publishedYes

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Urinary Diversion
Robotics
Operative Time
Efficiency
Cystectomy
Learning Curve
Conversion to Open Surgery
Recurrence
Lymph Node Excision
Urinary Bladder Neoplasms
Length of Stay
Body Mass Index
Lymph Nodes
Drug Therapy
Survival

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Desai, M. M., De Abreu, A. L. C., Goh, A. C., Fairey, A., Berger, A., Leslie, S., ... Gill, I. S. (2014). Robotic intracorporeal urinary diversion: Technical details to improve time efficiency. Journal of Endourology, 28(11), 1320-1327. https://doi.org/10.1089/end.2014.0284

Robotic intracorporeal urinary diversion : Technical details to improve time efficiency. / Desai, Mihir M.; De Abreu, Andre Luis Castro; Goh, Alvin C.; Fairey, Adrian; Berger, Andre; Leslie, Scott; Xie, Hui Wen; Gill, Karanvir S.; Miranda, Gus; Aron, Monish; Sotelo, Rene J.; Sun, Yinghao; Xu, Zhang; Gill, Inderbir Singh.

In: Journal of Endourology, Vol. 28, No. 11, 2014, p. 1320-1327.

Research output: Contribution to journalArticle

Desai, MM, De Abreu, ALC, Goh, AC, Fairey, A, Berger, A, Leslie, S, Xie, HW, Gill, KS, Miranda, G, Aron, M, Sotelo, RJ, Sun, Y, Xu, Z & Gill, IS 2014, 'Robotic intracorporeal urinary diversion: Technical details to improve time efficiency', Journal of Endourology, vol. 28, no. 11, pp. 1320-1327. https://doi.org/10.1089/end.2014.0284
Desai, Mihir M. ; De Abreu, Andre Luis Castro ; Goh, Alvin C. ; Fairey, Adrian ; Berger, Andre ; Leslie, Scott ; Xie, Hui Wen ; Gill, Karanvir S. ; Miranda, Gus ; Aron, Monish ; Sotelo, Rene J. ; Sun, Yinghao ; Xu, Zhang ; Gill, Inderbir Singh. / Robotic intracorporeal urinary diversion : Technical details to improve time efficiency. In: Journal of Endourology. 2014 ; Vol. 28, No. 11. pp. 1320-1327.
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abstract = "Objectives: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. Patients and Methods: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded. Results: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16{\%}) and 9 (24{\%}) patients, respectively. Over a median follow-up of 16 months, 12 (32{\%}) patients experienced disease recurrence and 9 (24{\%}) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64{\%} and 70{\%}, respectively. Conclusions: Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.",
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AU - Fairey, Adrian

AU - Berger, Andre

AU - Leslie, Scott

AU - Xie, Hui Wen

AU - Gill, Karanvir S.

AU - Miranda, Gus

AU - Aron, Monish

AU - Sotelo, Rene J.

AU - Sun, Yinghao

AU - Xu, Zhang

AU - Gill, Inderbir Singh

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N2 - Objectives: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. Patients and Methods: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded. Results: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow-up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively. Conclusions: Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.

AB - Objectives: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. Patients and Methods: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded. Results: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow-up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively. Conclusions: Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.

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