1163 LESSONS LEARNED FROM THE FIRST 71 CONSECUTIVE ROBOT-ASSISTED INTRA-CORPOREAL ILEAL CONDUITS THE ROSWELL PARK CANCER INSTITUTE EXPERIENCE

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121163 LESSONS LEARNED FROM THE FIRST 71 CONSECUTIVE ROBOT-ASSISTED INTRA-CORPOREAL ILEAL CONDUITS THE ROSWELL PARK CANCER INSTITUTE EXPERIENCE Faris S. Azzouni, Shabnam Rehman, Yi Shi, Andrew P. Stegemann, Gregory E. Wilding, and Khurshid A. Guru Faris S. AzzouniFaris S. Azzouni Buffalo, NY More articles by this author , Shabnam RehmanShabnam Rehman Buffalo, NY More articles by this author , Yi ShiYi Shi Buffalo, NY More articles by this author , Andrew P. StegemannAndrew P. Stegemann Buffalo, NY More articles by this author , Gregory E. WildingGregory E. Wilding Buffalo, NY More articles by this author , and Khurshid A. GuruKhurshid A. Guru Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1387AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Most series of Robot-assisted radical cystectomy (RARC) utilize an extracorporeal approach to ileal conduit creation. We report the perioperative and 90-day postoperative outcomes of the first 71 consecutive patients who underwent RARC with an intra-corporeal ileal conduit (ICIC) diversion, using the marionette technique. METHODS Intraoperative, pathologic and postoperative outcome measures were reviewed for the first 71 consecutive patients who underwent RARC and intra-corporeal ileal conduit diversions, and had ≥ 3-month postoperative follow-up. Patients were divided into 3 groups of 24, 24 and 23 patients each, to study the evolution of our surgical technique. A fellowship-trained urologic surgeon performed all operations. RESULTS Median overall operative (OT) and diversion (DT) times were 354 and 130 minutes, respectively. Median estimated blood loss (EBL) was 300 ml. Median lymph node yield was 26 and positive surgical margin rate (PSM) was 3%. Overall 90-day complication rate was 65% (69% were low grade). Infections were the most common complications, occurring in 25% of patients. Gastrointestinal and hematologic complications occurred in 23% and 15% of patients, respectively. Paralytic ileus was the most common early and overall individual complication (16%). There were no significant inter-group differences in any outcome measure studied, except median length of stay (p=0.006). CONCLUSIONS Robot-assisted Intra-corporeal ileal conduit is safe, feasible and reproducible. Furthermore, our 90-day complication rates are similar to larger open ileal conduit series. Group 1 Group 2 Group 3 Overall p-Value Overall (n) 24 24 23 71 Male 22 15 14 51 0.026 Female 2 9 9 20 Median BMI kg/m2 27.2 27.7 27.9 27.5 0.894 < cT2 (%) 4 8 9 7 0.865 ≥ cT2 (%) 96 92 91 93 Median Overall Operative Time (min) 350 349 367.5 354 0.650 Median Diversion Time (min) 140 120 130 130 0.595 Median EBL (mL) 350 325 300 300 0.844 Median LN yield 23.5 24 27 25.5 0.339 Positive Surgical Margins (n) 1 1 0 2 1.00 Median Length of Stay (days) 7 9 10 9 0.006 Clavien I-II (%) 42 38 57 45 0.689 Clavien III-V (%) 25 21 13 20 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e471-e472 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Faris S. Azzouni Buffalo, NY More articles by this author Shabnam Rehman Buffalo, NY More articles by this author Yi Shi Buffalo, NY More articles by this author Andrew P. Stegemann Buffalo, NY More articles by this author Gregory E. Wilding Buffalo, NY More articles by this author Khurshid A. Guru Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...