Intracorporeal Ileal Neobladder Research Articles

V06-05 INTRACORPORPOREAL ROBOTIC CONVERSION OF A NEOBLADDER TO AN ILEAL CONDUIT

You have accessJournal of UrologyCME1 Apr 2023V06-05 INTRACORPORPOREAL ROBOTIC CONVERSION OF A NEOBLADDER TO AN ILEAL CONDUIT Mohamed Eltemamy, Rathika Ramkumar, Patrick Michael, and Georges-Pascal Haber Mohamed EltemamyMohamed Eltemamy More articles by this author , Rathika RamkumarRathika Ramkumar More articles by this author , Patrick MichaelPatrick Michael More articles by this author , and Georges-Pascal HaberGeorges-Pascal Haber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video, we aim to describe the technique and feasibility of intracorporeal robotic conversion of a ileal neobladder to an ileal conduit. METHODS: This is a 68 years old male patient who had a robotic radical cystectomy and intracorporeal ileal neobladder for BCG refractory high risk non muscle invasive bladder cancer. He had his continent diversion for 7 years and was dependent on intermittent self-catheterization to empty his reservoir. After counselling the patient on his options, he elected to have a robotic conversion of his neobladder to an ileal conduit. RESULTS: The total operative time was 5 hours and 11 minutes. the estimated blood loss was minimal. No complications were noted and the patient was discharged on post operative day 1. We were able to reutilize the neobladder wall. This was done by partial resection of the pouch wall and reconfiguring the remaining wall in to a tube to reconstruct a new ileal conduit. In doing so, we avoided doing a new intestinal anastomosis and uretero-ileal anastomosis. CONCLUSIONS: We demonstrate the surgical steps for robotic conversion of a neobladder to an ileal conduit. This procedure is safe and technically feasible. Recycling the neobladder wall should always be favored over new construction of an ileal conduit as it avoids the need for intestinal anastomosis and redoing of an already patent uretero-ileal anastomosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e510 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Eltemamy More articles by this author Rathika Ramkumar More articles by this author Patrick Michael More articles by this author Georges-Pascal Haber More articles by this author Expand All Advertisement PDF downloadLoading ...

13 - Intracorporeal ileal neobladder with enhanced antireflux mechanism achieved by anterior repositioning of the afferent loop during robotic radical cystectomy with endopelvic fascia sparing approach

13 - Intracorporeal ileal neobladder with enhanced antireflux mechanism achieved by anterior repositioning of the afferent loop during robotic radical cystectomy with endopelvic fascia sparing approach

Robot-Assisted Intracorporeal Orthotopic Ileal Neobladder: Description of the "Shell" Technique.

Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (ICNB) remains a very complicated, technically demanding and time-consuming surgical procedure. In the current study we describe our robot-assisted intracorporeal “Shell” neobladder reconstruction. Methods: From January 2017 to December 2019, we performed 30 intracorporeal ileal neobladder “Shell” reconstructions. We prospectively collected demographics and clinical and pathological data and retrospectively analysed perioperative, functional and oncological outcomes. Results: No conversion to open surgery or intraoperative blood transfusion was necessary. The median whole operative time was 493 min (IQR 433–530 min), ranging from 514 min (IQR 502–554 min) recorded during the first ten procedures to 470 min (IQR 442–503 min) of the last ten. The median estimated blood loss was 400 mL (IQR 350–700 mL). The median length of stay was 11 days (IQR 10–17). Both early and late complication rates were 46.7%. The high-grade early complication rate accounted for 20%, while the high-grade late complication rate was 30%. The daytime continence rate registered was 73.3%, while night-time continence rate was 60%. Conclusions: Our results demonstrated “Shell” neobladder reconstruction as a technically feasible procedure, with good functional outcomes in tertiary referral centre. Longer follow-up and larger populations are needed to validate these preliminary results.

Locally Advanced Bladder Paraganglioma Managed with Robot-assisted Radical Cystectomy with Intracorporeal Neobladder- A Case Report

Paragangliomas are neuroendocrine tumours of extra-adrenal origin. Primary bladder paragangliomas are rare and have variable functional status, which presents a challenge in their management by minimally invasive surgery. Surgical resection necessitates minimal intraoperative handling of tumour, minimising physiological deterioration. Here in, a case is reported of incidentally detected locally advanced bladder paraganglioma which was managed successfully with robot-assisted radical cystectomy and intracorporeal ileal neobladder formation.

SC305 - Impact of learning curve on perioperative, oncologic and functional outcomes of robot-assisted radical cystectomy with intracorporeal ileal neobladder

SC305 - Impact of learning curve on perioperative, oncologic and functional outcomes of robot-assisted radical cystectomy with intracorporeal ileal neobladder

V06-08 ROBOT-ASSISTED RADICAL CYSTECTOMY AND HYBRID NEOBLADDER RECONSTRUCTION WITH THE AID OF GELPOINT DEVICE: TECHNICAL NUANCES AND PRELIMINARY RESULTS

INTRODUCTION AND OBJECTIVES:Robot-assisted cystectomy (RARC) with intracorporeal ileal neobladder can be offered to selected patients with muscle-invasive or high-risk non-muscle invasive bladder c...

Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer.

Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.

Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes.

BackgroundThis study compared the surgical and urinary functional outcomes in patients with muscle‐invasive bladder cancer (MIBC) who underwent robot‐assisted radical cystectomy (RARC) followed by intracorporeal ileal neobladder reconstruction (ICNB) to those in patients who underwent minimum incision endoscopic radical cystectomy (MIE‐RC) followed by extracorporeal ileal neobladder reconstruction (ECNB).Materials and MethodsThis study reviewed the clinical records of 153 consecutive MIBC patients who underwent neoadjuvant chemotherapy followed by radical cystectomy and ileal neobladder reconstruction.ResultsThe operative time in the ICNB group was significantly longer than that in the ECNB group. The median estimated blood loss was significantly less in the ICNB group than in the ECNB group. The neobladder capacity gradually increased in both groups. The maximum neobladder pressure and urethral closure pressure gradually improved in both groups.ConclusionOur initial experience with ICNB was favourable, with acceptable surgical and urinary functional outcomes.

Surgical techniques for facilitating laparoscopic intracorporeal orthotopic neobladder: initial experience.

ABSTRACTPurpose:To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction.Materials and Methods:From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic afferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported.Results:ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively.Conclusions:We described our experience of 3D LRC with a novel intracorporeal orthotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracorporeal neobladder with bilateral isoperistaltic afferent limbs.

Intuitive Anatomical Intracorporeal Neobladder Technique After Robot-Assisted Radical Cystectomy

Introduction: Radical cystectomy (RC) is one of the most complex urologic surgical procedures, especially in cases of orthotopic neobladder reconfiguration. Recently, robot-assisted radical cystectomy (RARC) demonstrated oncological results similar to those reported for open RC with promising outcomes and reduced procedure-related complications.1–4 Several techniques of totally intracorporeal neobladder diversion have been described, reporting satisfactory outcomes.5–11 In this video, we describe step-by-step the technique routinely employed in our Institute to perform a totally intracorporeal ileal neobladder. Patients and Methods: Between November 2013 and January 2016, 63 continent and neurologically healthy patients (54 men and 9 women) affected by muscle-invasive or high-risk bladder cancer refractory to instillation with Calmette–Guérin bacillus were recruited as candidates for RARC and orthotopic ileal neobladder. Urinary continence (UC) recovery was assessed at 30 days, 3, 6, and 12 months from catheter removal and was defined as no pad use or 1 pad per day for protection. Erectile function recovery was assessed at 6 and 12 months postoperatively and defined as an International Index Erectile Function score ≥17 and the possibility to have sexual intercourses with or without PDE5 inhibitors therapy. The intuitive anatomical intracorporeal-neobladder technique includes the following steps: (1) Identification of the optimal portion of the ileal loop to be led to the urethral stump and execution of anastomosis. (2) Defunctionalization of 60 cm of ileum and intestinal continuity restoration by laterolateral stapled anastomosis. (3) Inverted Y-shaped configuration of the neobladder. (4) Ureteral anastomosis on lateral ends of ileal loop stumps fixed to the psoas muscles bilaterally. (5) Completion of neobladder and leak test. Results: No intraoperative complications occurred. We reported early (<30 days) surgical complications in 14 (22%) patients, having Clavien grade 2 in 14 (22%) and grade 3 in 2 (3%) patients. Late complications, Clavien grade 3b, occurred in three (4%) patients. Daytime UC was preserved in 80% of male patients and sexual potency in 62% of patients receiving nerve sparing procedure. Conclusions: The goal of our technique was to offer a “user friendly” and reproducible neobladder reconfiguration. Peculiarities of our technique are the passage of two single-J stent through the catheter. This solution provides several potential advantages, such as (1) avoidance of the insertion of ureteral stents through the abdominal wall and (2) providing a single easy access to the urinary tract for irrigating procedures. Moreover, the configuration of the neobladder in an inverted Y shape, with the proximal ends fixed to the psoas muscle, allows to perform a ureteral–enteral anastomosis without the need to transpose the left ureter. Further advantage of this technique, with the two lateral stumps fixed to the psoas muscle, is to have at the end of the procedure a “pyramidal” shape of the neobladder, instead of a “cylindrical” shape, with improvement in the reservoir capacity and reducing intraluminal pressures. Overall complication rate was limited, offering a safe procedure profile. At 1 year follow-up, the majority of patients maintained daytime and nocturnal UC. No competing financial interests exist. Runtime of video: 5 min

VE26 - Robot-assisted radical cystectomy with intracorporeal ileal neobladder; Surgical technique and perioperative outcomes

VE26 - Robot-assisted radical cystectomy with intracorporeal ileal neobladder; Surgical technique and perioperative outcomes

Current status of robotic assisted radical cystectomy with intracorporeal ileal neobladder for bladder cancer.

To investigate the current status and feasibility of robotic neobladder diversion after robotic assisted radical cystectomy. A Medline search was conducted resulting in identification of 423 articles. After exclusion of ineligible studies, 3 case series and 5 case reports were considered with a total number of reported cases of 203. Although robotic intracorporeal neobladder reconstruction is in its starting phase, initial perioperative results seem to be comparable to open series. However, randomized studies are needed to confirm non-inferiority.

Robotic radical cystectomy with intracorporeal neobladder: Initial experience and outcomes.

Total intra-corporeal robot-assisted radical cystectomy (RARC) with total intracorporeal neobladder formation is relatively new in the treatment of bladder cancer. We present our experience and believe it is the first Canadian reported series with this technique. This is a case series of 4 patients, who underwent total RARC, pelvic lymphadenectomy and creation of an intra-corporeal ileal neobladder. Surgical technique is described and perioperative variables, pathologic data, and complication rates are reported. The mean patient age was 61.8 and the mean body mass index was 27.01 kg/m(2). The mean operative time, estimated blood loss, time to full diet and length of stay were 522.8 minutes (standard deviation [SD] 74.5), 237.5 mL (SD 47.9), 9 days (range: 3-24) and 12.8 days (range: 6-31), respectively. All patients completed postoperative functional evaluation showing a mean neobladder capacity of 575 cc (range: 500-720). Surgical margins and pathological nodal status were negative in all patients with no evidence of disease recurrence or progression on follow-up. Three of the 4 patients suffered a complication within 90 days, with one occurring later in the first year. All early complications were Clavien grade I-II (grade I [n = 1]; grade II [n = 2]) and the later complication was grade IIIa. The mean follow-up was 632 days (range: 562-730). The limitation of our study is its small sample size with highly selected patients to compensate for the learning experience. The follow-up is short; however, the outcomes are comparable to early experiences reported at other institutions. In our initial experience, RARC with total intracorporeal neobladder formation is safe. We expect that with experience the expense of robotic surgery can be compensated with early ambulation and shorter stay.

Y pouch neobladder-a simplified method of intracorporeal neobladder after robotic cystectomy.

In recent years, robot-assisted radical cystectomy (RARC) has shown similar oncologic outcomes compared with the gold standard open radical cystectomy with the added benefit of less blood loss and shorter hospital stay. Robot-assisted cystectomy with intracorporeal ileal neobladder is a complex surgical procedure and is usually performed in centers with experienced surgeons. We propose robot-assisted cystectomy with intracorporeal neobladder using the Y pouch previously described in open radical cystectomy. We think that the Y pouch is easier to perform than conventional spherical pouches without compromising functional outcomes. It may therefore be a good alternative for patients undergoing RARC with intracorporeal diversion.

Canada’s First Robotic Assisted Totally Intracorporeal Orthotopic Ileal Neobladder

Despite robotic-assisted radical cysto-prostatectomy being performed in several centres, the urinary diversion is most often performed extra-corporeal. A robotic intra-corporeal ileal neobladder is technically demanding and long-term functional outcome data is lacking. We performed a robotic intra-corporeal ileal neobladder in a 73-year-old man for muscle invasive non-metastatic bladder cancer. The total operative time was 6 hours 8 minutes. The estimated blood loss was 900 mL. There were no complications and he was discharged on day 12. The principles of open neobladder surgery were maintained, however key modifications were used to reduce technical difficulty and enable timely completion. We found that robotic intracorporeal ileal neobladder can be safely performed with an experienced robotic unit.

Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Totally Intracorporeal Ileal Neobladder

To describe robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal orthotopic ileal neobladder construction. With the use of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA), we performed laparoscopic radical cystectomy and intracorporeal construction of an orthotopic ileal neobladder (modified W pouch). The total operative time was 12 hours, and the estimated blood loss was 100 mL. There were no intraoperative or postoperative complications, and the patient?s hospital stay was 5 days. At early follow-up, oncologic and functional results are good. Robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal ileal neobladder construction is technically feasible. However, its role in the management of invasive bladder cancer remains to be defined.