V09-09 ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL ILEAL CONDUIT: SURGICAL TECHNIQUE, PERIOPERATIVE, FUNCTIONAL AND ONCOLOGIC OUTCOMES

Abstract

You have accessJournal of UrologyCME1 May 2022V09-09 ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL ILEAL CONDUIT: SURGICAL TECHNIQUE, PERIOPERATIVE, FUNCTIONAL AND ONCOLOGIC OUTCOMES Leonardo Misuraca, Gabriele Tuderti, Umberto Anceschi, Riccardo Mastroianni, Aldo Brassetti, Mariaconsiglia Ferriero, Alfredo Maria Bove, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Leonardo MisuracaLeonardo Misuraca More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A recent comparison between open, semi-robotic and totally robotic cystectomy with ileal conduit (IC), demonstrated that robotic intracorporeal IC is a complex procedure with increased operation time, but lower estimated blood loss, transfusion rates, complications and hospital stays. Moving towards a minimally invasive approach for all kind of urinary diversions, we recently standardized our technique for intracorporeal IC. In this video, we describe our surgical technique, reporting perioperative, functional and oncologic outcomes. METHODS: With patient in steep Trendelenburg position, 6-trocars access was used. Ureters were gently mobilized and isolated, avoiding tractions or manipulations. Distal ureters were clipped with hem-o-lok and a terminal specimen was sent for frozen section. Cystectomy with extended pelvic lymphadenectomy was completed, before transposing left ureter to the right side under the sigmoid mesentery. A 60 mm robotic stapler was used to congure the future IC and to perform a latero-lateral ileal-ileal anastomosis. Ureters were spatulated and, under ICG guidance to check ureters vascularity, a typical Wallace I anastomosis was performed. Two single J stents were positioned through a 5 mm trocar. The proximal end of the IC was opened and the posterior aspect of the uretero-ileal anastomosis was performed with a 3/0 monocryl running suture. The distal end of the IC was exteriorized by a Rampley forceps, together with the two single J stents. The anterior aspect of the uretero-ileal anastomosis was completed and a water tightness test was performed to prove the sealing of the suture. In this phase, camera port and right robotic arm were repositioned, in order to have a better visualization and an improved freedom of movements. Finally, peritoneum defect was closed in order to leave the IC in the retroperitoneum space. RESULTS: Overall, 61 patients with a median of 69 yr were treated. 36 patients had cT3 disease, 11 had evidence of lymphadenopathy and 2 had suspicious metastasis at preoperative imaging. Median operative time was 290 minutes. LOS was 9 days. Only 16.4% of patients required transfusion. 39.3% of patients experienced a perioperative complications of any grade, while severe complications (CD grade ≥3) occurred in only 2 patients. Overall, 50.8% of patients had a pT>2, while PSM were reported in 1.6% of patients. At a median follow up time of 23 months, we registered a median last creatinine of 1.33 mg/dL. Only 5 patients developed a grade 2 or 3 hydronephrosis, which required nephrostomy placement in 3 cases. 3-yr OS, DFS and MFS were 52.9, 43.9 and 47.6%, respectively. CONCLUSIONS: Robotic radical cystectomy with intracorporeal IC is a safe and feasible procedure, with minimized blood loss, improved convalescence and reduced complications rate in tertiary referral centers. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e807 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonardo Misuraca More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Riccardo Mastroianni More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Alfredo Maria Bove More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...