Totally robotic-assisted laparoscopic radical cystectomy with intracorporeal orthotopic U-shaped ileal neobladder

Abstract

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN). Methods A consecutive series of 4 patients (2 male, 2 female), who underwent RARC with TIOIN by a single surgeon, were included in the retrospective study, between March 2017 and June 2017. Their age ranged from 59 to 71 years, which the mean age was (65.7±4.9)years. Preoperative urinary CT scan, cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis. Among these, 2 patients underwent side-to-side bowel anastomosis using a linear stapler, while hand-sewn anastomosis was performed in the other 2 patients. The detubularized bowel segment was arranged in a U shape, and then the two medial borders were closed to create the posterior wall of the neobladder, which completed a partial U shape and anastomosed with the end of urethra. After placing the single J stents into the ureter, the uretero-neobladder was anastomosed.To close the urine reservoir, each border of the U-shaped segment was folded again and sutured to form a sealed pouch. Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min). The average operation time for urinary diversion was 214.2 min (ranging 163-251 min). The mean estimated blood loss was 304.5 ml(ranging 200-400 ml). The mean hospital stay was 20.5 d (ranging 13-32 day). The number of dissected lymph node ranged from 11 to 16 (mean 3.7±2.6). All the surgical margins were negative. The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days, respectively. The single-J stents were removed 1 months after operation, generally.No urine leakage was noticed after removing the drainage tube and catheter. The lymph leakage was observed in one case, which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory, except one patient complained about the nocturnal incontinence. After the regular pelvic exercise, the symptom improved two months after the operation. Hydronephrosis and intestinal leakage were not observed. Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon. Key words: Bladder cancer; Robot; Robot-assisted radical cystectomy; Intracorporeal orthotopic ileal neobladder