PD38-07 ROBOT-ASSISTED INTRACORPOREAL RIGHT COLON CONTINENT CUTANEOUS URINARY DIVERSION AND AUGMENTATION CYSTOPLASTY: A SINGLE INSTITUTION EXPERIENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2017PD38-07 ROBOT-ASSISTED INTRACORPOREAL RIGHT COLON CONTINENT CUTANEOUS URINARY DIVERSION AND AUGMENTATION CYSTOPLASTY: A SINGLE INSTITUTION EXPERIENCE Spencer Craven, John Sigalos, Rose Khavari, and Alvin Goh Spencer CravenSpencer Craven More articles by this author , John SigalosJohn Sigalos More articles by this author , Rose KhavariRose Khavari More articles by this author , and Alvin GohAlvin Goh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1721AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Continent cutaneous diversion (CCD) is a less commonly utilized diversion choice following open or robotic cystectomy. We have previously described a novel technique for robotic intracorporeal CCD. Meanwhile, continent cutaneous augmentation cystoplasty (CCAC) is a viable option for patients with neurogenic bladder. There is limited worldwide experience performing intracorporeal CCD and no studies describing intracorporeal CCAC. Principles developed in robotic CCD can be readily applied to robotic CCAC. We share our experience with these novel robotic procedures. METHODS Robotic cystectomy was performed in patients undergoing CCD using a standard 6-port technique. The patient and robot were then repositioned for intracorporeal bowel mobilization and segmentation, ileocolonic anastomosis, uretero-colonic anastomoses, pouch construction, tapering of catheterization channel, reinforcement of ileocecal valve, and stoma creation. All patients were placed on an evidence-based Enhanced Recovery after Surgery protocol postoperatively. Operative times, intraoperative blood loss (EBL), length of stay (LOS), and complications occurring within 90 days of surgery were reviewed. RESULTS Ten robotic intracorporeal right colon urinary diversions, including four robotic intracorporeal CCAC and six robotic intracorporeal CCD, were performed. Mean total operative times for cystectomy and intracorporeal urinary diversion were 7.8 and 10 hours for CCAC or CCD respectively (5.4-9.5; 7.9-12.9). Mean EBL was 181ml (75-300) for CCAC and 250ml (100-500) for CCD. Mean LOS for CCAC and CCD groups was 10 and 8.8 days respectively (5-18, 4-18). A single CCAC patient required transfusion postoperatively. Two high grade complications (Clavien III or greater) were reported in the CCAC group (50%). One high grade complication was reported in the CCD group (17%). Within 30 days of surgery, no CCAC and two CCD patients required readmission (0%, 33%). With a median follow up of 17 months, no incontinence was reported and all patients were able to catheterize without difficulty. CONCLUSIONS We demonstrate that robotic intracorporeal CCD and CCAC are technically feasible and safe with good functional outcomes. Further evaluation of these novel surgical techniques along with comparative studies are needed. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e742 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Spencer Craven More articles by this author John Sigalos More articles by this author Rose Khavari More articles by this author Alvin Goh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...