MP5-10 ROBOTIC INTRA-CORPOREAL ORTHOTOPIC NEOBLADDER DURING RADICAL CYSTECTOMY: 132 PATIENTS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-10 ROBOTIC INTRA-CORPOREAL ORTHOTOPIC NEOBLADDER DURING RADICAL CYSTECTOMY: 132 PATIENTS Mihir M. Desai, Inderbir Gill, Abolfazl Hosseini, Tommy Nyberg, Christofer Adding, Oscar Laurin, Justin Collins, Andre Luis Abreu, Alvin Goh, Monish Aron, and Peter Wiklund Mihir M. DesaiMihir M. Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Tommy NybergTommy Nyberg More articles by this author , Christofer AddingChristofer Adding More articles by this author , Oscar LaurinOscar Laurin More articles by this author , Justin CollinsJustin Collins More articles by this author , Andre Luis AbreuAndre Luis Abreu More articles by this author , Alvin GohAlvin Goh More articles by this author , Monish AronMonish Aron More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present a 2-institutional experience with completely intra-corporeal robotic orthotopic neobladder and robotic radical cystectomy in 132 patients. METHODS Of 246 robotic intra-corporeal diversions, 132 were neobladders. All neobladders were constructed intra-corporeally in a globular configuration, completely duplicating established open surgical techniques. Demographics: mean age 60 years, BMI 27, female patients n=18 (14%), status-post neo-adjuvant chemotherapy n=30 (23%). Technical details: nerve-sparing in 56% of male patients, female organ-preserving in 32% of female patients; Lymphadenectomy: Extended (upto aortic bifurcation): n=51 (39%), Super-extended (upto IMA): n=20 (15%); Uretero-ileal anastomoses: Wallace-type (n=86; 65%), Bricker-type (n=46; 35%). Data were prospectively collected. Patients were retrospectively divided into chronologic groups to assess learning curve trends. RESULTS Mean data: OR time 7.6 hrs (4.4-13), blood loss 430 cc (50-2200), hospital stay 11 days (3-78). Complications: Clavien grade I, II, IIIa, IIIb, IV and V: Within 30 days: 7%, 25%, 9%, 4%, 2% and 0%; Between 30-90 days: 5%, 9%, 2%, 8%, 1% and 1.5%. Bowel complications: n=2 (1.5%) (ileo-neobladder fistula, bowel leak). Benign uretero-enteric strictures: n=5 (3.8 %). On comparing the initial 25 with the latest 32 patients, outcomes improved significantly: mean OR time (8.2 vs 7.3 hrs), blood loss (694 vs 319 cc) and hospital stay (12.6 vs 7.7 d). Positive surgical margin: n=1 (0.8%). Mean nodal yield: 29 (7-164), node-positivity rate was 17%. Over a mean follow-up of 2.1 years (0.1-9.8), cancer recurred in 20 patients (15%), 5-year overall, cancer-specific and recurrence-free survival was 72%, 72% and 71%, respectively. CONCLUSIONS Robotic intra-corporeal orthotopic neobladder diversion is now a developed and refined technique, diligently duplicating open principles. Operative efficiency and peri-operative outcomes have improved significantly with experience. Nodal yield, pathologic data and 5-year oncologic outcomes are equivalent to open surgery. As the next step, we propose a randomized controlled trial with open radical cystectomy/neobladder surgery, including objective assessment of functional outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e85-e86 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mihir M. Desai More articles by this author Inderbir Gill More articles by this author Abolfazl Hosseini More articles by this author Tommy Nyberg More articles by this author Christofer Adding More articles by this author Oscar Laurin More articles by this author Justin Collins More articles by this author Andre Luis Abreu More articles by this author Alvin Goh More articles by this author Monish Aron More articles by this author Peter Wiklund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...