Robotic Cystectomy with Intracorporeal Urinary Diversion is Associated with Decreased Narcotic Consumption

Abstract

Introduction: Improvements in robotic technology and surgeon experience have made intracorporeal ileal conduit urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC) a reality. Thus, it is essential to understand the benefits and drawbacks to this technically challenging approach. This study investigates surgical and pain-related perioperative outcomes in patients who underwent ICUD compared to extracorporeal urinary diversion (ECUD) at a tertiary care center. Methods: We reviewed a prospectively maintained database of 198 patients who underwent robot-assisted radical cystectomy between January 2015 and October 2020. Surgical, functional, and pain-related perioperative outcomes were compared between 177 patients who received either ICUD or ECUD. Results and Conclusion: Among 177 patients, 107 (60.4%) patients underwent ECUD and 70 (39.6%) underwent ICUD. Patients who received ICUD had significantly lower narcotic consumption (P=.031). There were no significant differences across cohorts in operative time (P=.10), estimated blood loss (P=.958), blood transfusion rate (P=.267), overall survival (P=.485), LOS (P=.652), or 30-day readmissions (P=.080). Our study suggests that RARC with intracorporeal ileal conduit reduces post-operative narcotic use as compared to extracorporeal diversion. Further validation across multiple institutions will be required to elucidate the full advantage and/or disadvantage to this approach.