Simultaneous Perineal Urethrectomy and Robotic Radical Cystectomy with Extended Pelvic Lymph Node Dissection and Intracorporeal Ileal Conduit

Abstract

Objective: To describe the feasibility and time effectiveness of simultaneous perineal urethrectomy and robotic cystectomy with total intracorporeal ileal conduit. Methods: After approval by the institutional review board, we included all consecutive patients who underwent perineal urethrectomy with simultaneous robot-assisted radical cystectomy (RARC) and intracorporeal ileal conduit (ICIC) with the Da Vinci Xi robot, in our institution from January 1, 2018, to September 15, 2018. We compared peroperative data with another group of patients who underwent RARC with ICIC without urethrectomy in our institution during the same period. Results: In total, there were 2 patients in the simultaneous urethrectomy group and 14 patients in the no urethrectomy group. Extended lymph node dissection was done for all patients in both groups. Firefly was used for urinary diversion in all cases in both groups. There was no significant difference between the operative time in the simultaneous urethrectomy group (370 minutes) and the no urethrectomy group (360 minutes) (p = 0.09). Both simultaneous urethrectomy patients were able to exit the hospital on day 5 and day 7, respectively. In the first 30 days (early complications), the highest Clavien complication for the first patient was Grade I (ileus treated with antiemetics and surveillance) and for the second patient a Grade II (pneumonia treated with antibiotics). We did not record any complications specific to the urethrectomy procedure. None of these two patients presented late complications (31–90 days). Conclusion: Perineal urethrectomy with simultaneous RARC and ICIC is a feasible and time-efficient procedure similar to RARC and ICIC without perineal urethrectomy. No competing financial interests exist. Runtime of video: 7 mins 58 secs