The patient-side surgeon plays a key role in facilitating robot-assisted intracorporeal ileal conduit urinary diversion in men

Masayuki Takahashi,Megumi Tsuda,Keisuke Ozaki,Tomoya Fukawa,Yutaro Sasaki,Kei Daizumoto,Yoshito Kusuhara,Hirofumi Izaki,Kazuya Kanda,Yoshiteru Ueno,Keito Shiozaki,Yasuyo Yamamoto,Kunihisa Yamaguchi,Hiroomi Kanayama,Kyotaro Fukuta

doi:10.1007/s11701-021-01256-x

Abstract

The influence of the console surgeon on the feasibility and outcome of various robot-assisted surgeries has been evaluated. These variables may be partially affected by the skills of the patient-side surgeon (PSS), but this has not been evaluated using objective data. This study aimed to describe the surgical techniques of the PSS in robot-assisted radical cystectomy (RARC) and intracorporeal ileal conduit (ICIC) urinary diversion and objectively examine the changes in surgical outcomes with increasing PSS experience. During a 3-year period, 28 men underwent RARC and ICIC urinary diversion. Clinical characteristics and surgical outcomes were compared between patients who underwent surgery early (first half group) or late in the study period (second half group). The pre-docking incision enabled easy specimen removal. The glove port technique widened the working space of the PSS. The stay suture allowed the PSS to control the distal portion of the conduit, facilitating the passage of the ureteral stents. During stoma creation, pneumoperitoneum pressure was lost by opening the abdominal cavity. To overcome this problem, the robotic arm was used to lift the abdominal wall to maintain the surgical field and facilitate the PSS procedure. Compared with the first half group, the second half group had significantly shorter times for urinary diversion (202 min vs 148 min, p < 0.001), ileal isolation and anastomosis (73 min vs 45 min, p < 0.001), and stenting (23.0 min vs 6.5 min, p < 0.001). As the experience of the PSS increased, the time of the PSS procedures decreased.

Highlights

The literature on robot-assisted surgery focuses on the feasibility, surgical outcomes, and the experience or learning curve of the main console surgeon (CS) [1]
The patientside surgeons (PSS) plays a key role in robot-assisted radical cystectomy (RARC), especially in intracorporeal urinary diversion (ICUD); there is a lack of objective data to support this
Among the surgical processes in ICUD, the most important surgical steps for the PSS to contribute to the achievement of a smooth operation while maintaining minimally invasive surgery (MIS) are the creation of the ileal conduit, removal of the specimen, passage of the ureteral stent, and creation of the stoma

Summary

Introduction

The literature on robot-assisted surgery focuses on the feasibility, surgical outcomes, and the experience or learning curve of the main console surgeon (CS) [1]. These variables may partially depend on the skills of the patientside surgeons (PSS). The PSS must promote the smooth performance of ICUD and aim for minimally invasive surgery (MIS). Among the surgical processes in ICUD, the most important surgical steps for the PSS to contribute to the achievement of a smooth operation while maintaining MIS are the creation of the ileal conduit, removal of the specimen, passage of the ureteral stent, and creation of the stoma.

Objectives

Methods

Results

Conclusion