Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique

Andre Luis De Castro Abreu, Sameer Chopra, Raed A. Azhar, Andre K. Berger, Gus Miranda, Jie Cai, Inderbir S. Gill, Monish Aron, Mihir M. Desai

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Introduction: Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results. Materials and Methods: Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC) and neobladders (NB). SAS® Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05. Results: Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57). All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01) and orthotopic NB (13 vs. 7.5-day, P < 0.01) when comparing the first third of the cohort with the rest of the group. Overall median (range) operative time and estimated blood loss was 7 h (4.8-13) and 200 mL (50-1200), respectively. Within 30-day postoperatively, complications occurred in 61 (59%) patients, with the majority being low grade (n = 43), and no patient died. Median (range) nodes yield was 36 (0-106) and 4 (3.9%) specimens had positive surgical margins. Conclusions: Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.

Original languageEnglish (US)
Pages (from-to)300-306
Number of pages7
JournalIndian Journal of Urology
Volume30
Issue number3
DOIs
StatePublished - 2014

Keywords

  • Bladder cancer
  • intracorporeal urinary diversion
  • robot-assisted radical cystectomy
  • robotic
  • urinary diversion

ASJC Scopus subject areas

  • Urology

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    De Castro Abreu, A. L., Chopra, S., Azhar, R. A., Berger, A. K., Miranda, G., Cai, J., Gill, I. S., Aron, M., & Desai, M. M. (2014). Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique. Indian Journal of Urology, 30(3), 300-306. https://doi.org/10.4103/0970-1591.135673