Initial Experience of Robot-Assisted Radical Cystectomy with Total Intracorporeal Urinary Diversion: Comparison with Extracorporeal Method

Kang, Sung Gu; Ko, Young Hwii; Jang, Hoon A.; Kim, Jin; Kim, Seon Han; Cheon, Jun; Kang, Seok Ho
July 2012
Journal of Laparoendoscopic & Advanced Surgical Techniques;Jul/Aug2012, Vol. 22 Issue 6, p456
Academic Journal
Purpose: To report our surgical technique and initial experience with robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal urinary diversion compared with an extracorporeal method. Subjects and Methods: In total, 42 patients underwent RARC by a single surgeon at our institute for clinically localized bladder cancer. Among these, 4 patients underwent RARC with complete intracorporeal urinary diversion. An ileal conduit was achieved in 3 patients, and an orthotopic neobladder was created in 1 patient. Our surgical technique is presented in detail, and the intracorporeal cases were compared with 38 previous extracorporeal diversion cases for perioperative outcome, postoperative oncologic outcome, and complications. Results: Three men and 1 woman underwent complete intracorporeal urinary diversion. In patients receiving ileal conduits the mean total operative time was 510 minutes, and the estimated blood loss was 400 mL. In the patient receiving an ileal neobladder the total operative time was 585 minutes, and the estimated blood loss was 500 mL. Mean time to flatus was 60 hours, and no intraoperative or postoperative major complications occurred. Surgical margins were negative with no positive lymph nodes. Compared with extracorporeal cases, the mean total operative time for RARC was significantly longer, but perioperative outcomes of estimated blood loss, time to flatus, and postoperative oncologic outcomes were not significantly different. Conclusions: Our initial experience showed that RARC with complete intracorporeal urinary diversion is feasible based on perioperative data and oncologic features. However, in this small case series, we observed no definite benefits associated with intracorporeal urinary diversion over extracorporeal urinary diversion except for better cosmesis. Long-term, large-scale, prospective comparative studies will be needed to demonstrate the benefit of intracorporeal urinary diversion.


Related Articles

  • Robot-Assisted Intracorporeal Formation of the Ileal Neobladder. Tyritzis, Stavros I.; Hosseini, Abolfazl; Jonsson, Martin; Adding, Christofer; Nilsson, Andreas; Wiklund, N. Peter // Journal of Endourology;Dec2012, Vol. 26 Issue 12, p1570 

    We are celebrating the 10th anniversary of robot-assisted laparoscopic radical cystectomy (RARC) with urinary diversion (UD), and it seems that this operation is successfully following the footsteps of robot-assisted laparoscopic radical prostatectomy. Until now, approximately 1000 RARCs have...

  • Does Body Mass Index Impact the Performance of Robot-Assisted Intracorporeal Ileal Conduit? Poch, Michael A.; Stegemann, Andrew; Chandrasekhar, Rameela; Hayn, Mathew; Wilding, Gregory; Guru, Khurshid A. // Journal of Endourology;Jul2012, Vol. 26 Issue 7, p857 

    Background and Purpose: Body mass index (BMI) has been shown to influence perioperative outcomes for patients undergoing open radical cystectomy and urinary diversion. The impact of BMI on robot-assisted intracorporeal ileal conduit has not been studied. Patients and Methods: All patients...

  • 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 // Journal of Endourology;Nov2014, Vol. 28 Issue 11, p1320 

    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...

  • Robot-Assisted Radical Cystectomy Using a Side-Docking Technique. Chan, Eddie Shu-yin; Yee, Chi-hang; Chiu, Peter Ka-fung; Chan, Chi-kwok; Hou, See-ming; Ng, Chi-fai // Journal of Laparoendoscopic & Advanced Surgical Techniques;Mar2015, Vol. 25 Issue 3, p207 

    Purpose: Robot-assisted radical cystectomy (RARC) was first introduced in 2003. Although there have been modifications to the surgical techniques over the years, in every published RARC series the surgical robot is invariably docked between the patient's legs. We evaluated the use of a...

  • Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes. Liss, Michael; Kader, A. // World Journal of Urology;Jun2013, Vol. 31 Issue 3, p489 

    Objective: Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context...

  • Standardized analysis of complications after robot-assisted radical cystectomy: Korea University Hospital experience. Jong Hyun Pyun; Hyung Keun Kim; Jae Yoon Kim; Seung Bin Kim; Seok Cho; Sung Gu Kang; Young Hwii Ko; Jun Cheon; Jeong Gu Lee; Je Jong Kim; Seok Ho Kang // Korean Journal of Urology;Jan2015, Vol. 56 Issue 1, p48 

    Purpose: To analyze the complications after robot-assisted radical cystectomy (RARC) by use of a standardized reporting methodology by a single surgeon. Materials and Methods: We prospectively reviewed a maintained institutional database of 52 patients who underwent RARC to manage bladder cancer...

  • Is robotic-assisted radical cystectomy (RARC) with intracorporeal diversion becoming the new gold standard of care? Patel, Hitendra; Santos, Pedro; Oliveira, Manuel; Müller, Stig // World Journal of Urology;Jan2016, Vol. 34 Issue 1, p25 

    Background: Totally intracorporeal robotic-assisted radical cystectomy (RARC) has perceived difficulties compared to open radical cystectomy (ORC). As the technique is increasingly adopted around the world, the benefits of RARC with intra- or extracorporeal urinary diversion or ORC for the...

  • Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Tan, Wei Shen; Khetrapal, Pramit; Tan, Wei Phin; Rodney, Simon; Chau, Marisa; Kelly, John D. // PLoS ONE;11/7/2016, Vol. 11 Issue 11, p1 

    Background: The number of robotic assisted radical cystectomy (RARC) procedures is increasing despite the lack of Level I evidence showing any advantages over open radical cystectomy (ORC). However, several systematic reviews with meta-analyses including non-randomised studies, suggest an...

  • A Comparative Cost Analysis of Robot-Assisted Versus Traditional Laparoscopic Partial Nephrectomy. Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K.; Ward, Maryann; Allaf, Mohamad // Journal of Endourology;Jul2012, Vol. 26 Issue 7, p843 

    Background and Purpose: Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics