Abstract
Robotic intracorporeal neobladder (RIN) is increasingly the modality of choice for intracorporeal urinary diversion in high-volume Robotic Urology centers. This article details the modern technique of RIN, explains specific tips and tricks to facilitate timely operative progression as well as weighs the outcomes from recently published series. An OVID/EMBASE database search was done using keywords: robotic, cystectomy, intracorporeal neobladder, orthotopic, and intracorporeal urinary diversion. The inclusion criteria were original studies on Robot-Assisted Radical Cystectomy (RARC) with RIN series, available in full text in English, published over the last ten years with a specific analysis of oncological and functional outcomes. Pooled data analysis of the 10 studies included shows 80% of patients had organ-confined disease (≤pT2), 1.86% of patients had positive surgical margin, median lymph node yield of 23 nodes (IQR = 7.5), and cancer-specific survival rate of 78% (range 72%-100%) over a mean follow up of 27.43 months (range 13-37 months). Functionally, the median day continence rate is 81.5%, night continence rate is 61%, and rate of return to spontaneous sexual activity is 33.5%. This compares favorably with outcomes of The International Robotic Cystectomy Consortium - Extracorporeal Urinary Diversion data and data from open radical cystectomy (ORC) neobladder series with long term follow up. High-volume robotic centers have successfully introduced programs for RARC, with RIN demonstrating its safety and feasibility. Their results suggest potential to improve perioperative and functional outcomes over ORC. Moreover, under mentorship, surgeons can learn the technique of RARC and RIN without these outcomes being significantly affected.
Highlights
Surgical treatment of muscle-invasive (MIBC) and high-risk non-muscle-invasive bladder cancer is uniformly recommended
It is reflected in the widespread adoption of Robot-Assisted Radical Cystectomy (RARC) and robotic intracorporeal neobladder (RIN) by high-volume robotic urological centers
Between 2015 and 2018, 70% in North America and 50% in Europe of Radical Cystectomy (RCs) performed were done robotically[1], with an increase in intracorporeal urinary diversion (ICUD) from 9% to 97% between 2005 and 2015[2]. This increase in ICUD was primarily accounted for by centers performing intracorporeal ileal conduit, which increased from 2% to 81%, rather than RIN, which only increased from 7% to 17%[2]
Summary
Surgical treatment of muscle-invasive (MIBC) and high-risk non-muscle-invasive bladder cancer is uniformly recommended. RIN: Robotic intracorporeal neobladder; RARC: robot-assisted radical cystectomy; OT: operating time; EBL: estimated blood loss.
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