V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY

Abstract

You have accessJournal of UrologyRobotics-Bladder/Reconstruction1 Apr 2016V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY Andre Luis de Castro Abreu, Giuseppe Simone, Sameer Chopra, Mariaconsiglia Ferriero, Rocco Papalia, Nariman Ahmadi, Riccardo Mastroianni, Daniel Park, Andre Berger, Salvatore Guaglianone, Rene Sotelo, Michelle Gallucci, Monish Aron, Inderbir Gill, and Mihir Desai Andre Luis de Castro AbreuAndre Luis de Castro Abreu More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Nariman AhmadiNariman Ahmadi More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Daniel ParkDaniel Park More articles by this author , Andre BergerAndre Berger More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Rene SoteloRene Sotelo More articles by this author , Michelle GallucciMichelle Gallucci More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2115AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Continent cutaneous diversion is an option for patients undergoing cystectomy. Herein we report our experience of 10 consecutive patients who underwent completely intracorporeal robotic Indiana Pouch construction following robotic cystectomy. METHODS Surgical steps: Robotic cystectomy and pelvic lymph node dissection (PLND) are performed with a 6-trocar access. Robot is undocked and specimen extracted from the left lateral port. Both left side ports are closed and three additional ports are placed. Table is rotated 45 degree to left and the robot is re-docked on right side. Replicating open techniques: 12 cm of distal ileum and 30cm of right colon are isolated; side to side stapled ileocolonic anastomosis is performed; colonic segment is detubularized along the antimesenteric tenia up to 3cm distal to the ileocecal valve and U folded. The medial aspect of the folded colon is sewn. Ureterocolonic anastomoses are performed on the posterior aspect of the pouch. Bilateral J stents are placed in ureters and secured to a 24-Fr hematuria catheter inserted via the appendiceal orifice. After closing the lateral aspect of the pouch, a Foley catheter is inserted via the umbilical port and through efferent ileal limb and placed into the colonic pouch. The efferent limb is tapered with a 60mm stapler on the antimesenteric aspect. The ileocecal valve and the efferent limb are plicated to increase the outflow resistance. The efferent limb is now extracted and the stoma created at the umbilical site. RESULTS There were no intraoperative complications and all procedures (n=10) were successfully completed robotically. Median operative times were 60 min for cystectomy, 65 min for PLND, 45 min for repositioning/re-docking and 210 min for pouch construction. The median overall operative time was 365 (295-540) min. No patients were transfused. Median hospital stay was 9 days. 30-day complication rate was 40%. There were no grade 3 or 4 complications. At 3-month follow-up urodynamics demonstrated a mean maximum capacity of 270mL without ureteral reflux and minimal urine residual; 9 patients (90%) reported full continence. No patient died. CONCLUSIONS Robotic Indiana pouch can be safely performed, completely intracorporeally. This technique provides a minimally-invasive, time efficient approach with acceptable complication rates. Patients undergoing radical cystectomy can now be offered all types of urinary diversions robotically. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e61 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Andre Luis de Castro Abreu More articles by this author Giuseppe Simone More articles by this author Sameer Chopra More articles by this author Mariaconsiglia Ferriero More articles by this author Rocco Papalia More articles by this author Nariman Ahmadi More articles by this author Riccardo Mastroianni More articles by this author Daniel Park More articles by this author Andre Berger More articles by this author Salvatore Guaglianone More articles by this author Rene Sotelo More articles by this author Michelle Gallucci More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...