Intracorporeal Neobladder Formation Research Articles

The feasibility of robot-assisted radical cystectomy: an experimental study.

To investigate the feasibility of the avatera system for performing robot-assisted radical cystectomy (RARC) followed by intracorporeal reconstruction of ileal neobladder. Six anesthetized female pigs were used to perform RARC and formation of the intracorporeal orthotopic ileal neobladder. Three surgeons with different level of expertise in the use of robotic systems performed RARC after a short instructional lecture and a 2-h hands-on training. The urinary diversion phase was performed only by the experienced surgeon. The successful completion of the procedure, operative time for demolitive and reconstructive phases, intraoperative blood loss and malfunction of the robotic system were evaluated. An improvement of the operative time was observed for each surgeon. The experienced surgeon, the fellow and the resident improved their time by 11, 15, and 22min, respectively, between the first and the second RARC performed. The most significant time difference was demonstrated by the resident, who had no previous experience in using robotic systems. The time difference between the first and the last orthotopic ileal neobladder creation for the experienced surgeon was 51min. The feasibility of avatera system for performing complex surgical procedure such as RARC with intracorporeal neobladder formation was demonstrated by this experimental study. No major bleeding or severe malfunctions were observed during the procedures. Significant improvement in operative time was demonstrated with the increasing experience from 1st to 6th case.

V13-08 ROBOTIC INTRACORPOREAL ORTHOTOPIC ILEAL NEOBLADDER: REPLICATING OPEN SURGICAL PRINCIPLES OF Y-SHAPED TECHNIQUE

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-08 ROBOTIC INTRACORPOREAL ORTHOTOPIC ILEAL NEOBLADDER: REPLICATING OPEN SURGICAL PRINCIPLES OF Y-SHAPED TECHNIQUE Tommaso Silvestri, Federico Germinale, Giovanni Costa, Bernardino De Concilio, Guglielmo Zeccolini, Giorgio Mazzon, and Antonio Celia Tommaso SilvestriTommaso Silvestri More articles by this author , Federico GerminaleFederico Germinale More articles by this author , Giovanni CostaGiovanni Costa More articles by this author , Bernardino De ConcilioBernardino De Concilio More articles by this author , Guglielmo ZeccoliniGuglielmo Zeccolini More articles by this author , Giorgio MazzonGiorgio Mazzon More articles by this author , and Antonio CeliaAntonio Celia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is the fourth most common cancer diagnosed in men in the Europe and currently radical cystectomy is yet the gold-standard treatment in patient fit for surgery. In the last five years, there was a progressively evolution in robotic technique for ileal neobladder. Herein, we describe our step-by-step technique for robotic intracorporeal neobladder formation. METHODS: We present the case of a 59 years old patient with a diagnosis of an muscular-invasive bladder cancer underwent neoadjuvant chemotherapy and then radical cystectomy and super-extended bilateral pelvic lymphadenectomy. The presented video is a focus on our approach and technique for the configuration of the Y-shaped neobladder. The main surgical steps to forming the intracorporeal orthotopic ileal neobladder are: isolation of 45 cm of small bowel (length varies in relation to the characteristics of ileum); neobladder-urethral anastomosis; small bowel anastomosis; bowel detubularisation; suture of the posterior wall of the neobladder; and cross folding of the pouch; and uretero-enteral anastomosis. Improvements have been made to these steps to enhance time efficiency without compromising neobladder configuration. RESULTS: From January 2017 to July 2020 we performed our technique in 25 patients. Our technical improvements have resulted in a decreasing in operative time from 400 to 200 min. Postoperative surgical complications occurred in four of the 18 patients (22.1%), including one surgical Clavien-Dindo Grade III and three Grade I, postoperative medical Clavien-Dindo Grade II complications occurred in three (16.7%) patients. On urodynamic examination (available in 5 [20%] patients) the median (IQR) reservoir cystometric capacity, compliance, and post-void residual were 220 (190-256) mL, 17 (11.8-20.1) mL/cmH2 O, and 0 (0-56) mL, respectively. CONCLUSIONS: We describe our step-by-step technique of robot-assisted intracorporeal orthotopic ileal neobladder formation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1080-e1080 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tommaso Silvestri More articles by this author Federico Germinale More articles by this author Giovanni Costa More articles by this author Bernardino De Concilio More articles by this author Guglielmo Zeccolini More articles by this author Giorgio Mazzon More articles by this author Antonio Celia More articles by this author Expand All Advertisement Loading ...

Робот-ассистированная радикальная цистэктомия с ортотопической деривацией мочи

Introduction Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. Aim To describe the main stages of RARC and to analyze its short-term results. Materials and methods RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. Results The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. Conclusion RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.

Сравнительный анализ результатов экстра- и интракорпорального формирования мочевого резервуара при эндовидеохирургической радикальной цистэктомии

The aim of the study is to compare the results and complications of muscle- invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation. Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden). In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases - Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis. Due to medical technologies development and endovideo-surgical equipment improving, it became possible to perform high-technological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.

Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique.

To describe our, step-by-step, technique for robotic intracorporeal neobladder formation. The main surgical steps to forming the intracorporeal orthotopic ileal neobladder are: isolation of 65 cm of small bowel; small bowel anastomosis; bowel detubularisation; suture of the posterior wall of the neobladder; neobladder-urethral anastomosis and cross folding of the pouch; and uretero-enteral anastomosis. Improvements have been made to these steps to enhance time efficiency without compromising neobladder configuration. Our technical improvements have resulted in an improvement in operative time from 450 to 360 min. We describe an updated step-by-step technique of robot-assisted intracorporeal orthotopic ileal neobladder formation.

Management of Challenging Urethro-ileal Anastomosis During Robotic Assisted Radical Cystectomy with Intracorporeal Neobladder Formation

BackgroundRobotic assisted radical cystectomy (RARC) is increasingly being adopted, but intracorporeal neobladder formation remains a challenging procedure limited to selected centers. Common challenges with intracorporeal neobladder formation relate to fashioning a tension-free urethro-ileal anastomosis. In this paper, we describe a series of maneuvers to overcome these challenges that we believe will be of great utility to surgeons performing intracorporeal neobladder. ObjectiveTo describe maneuvers to overcome challenges during intracorporeal urethro-ileal anastomosis formation and to report postoperative outcomes for patients in whom these maneuvers were used. Design, setting, and participantsA retrospective review of medical records of patients who underwent RARC with intracorporeal neobladder performed by one surgeon (G.-P.H.) at our tertiary center from January 2012 to February 2015 in which at least one additional maneuver was required beyond preservation of urethral length, removal of the sigmoid colon from the pelvis, and careful ileal loop selection. The primary end point was 90-d complications. Follow-up ranged from 6 to 36 mo, and 16 patients had at least 1-yr follow-up. Surgical procedureRARC with intracorporeal neobladder formation. Outcome measurements and statistical analysesClinical and operative data collected from a prospectively maintained, institutional review board–approved database. Maneuvers used during intracorporeal urethro-ileal anastomosis were recorded. Descriptive statistics were used to evaluate postoperative outcomes. Results and limitationsNineteen patients met the inclusion criteria. Mean operative time was 486min (standard deviation: 112min) with median hospitalization of 7 d (interquartile range: 7–9 d). Seven patients (36.8%) experienced a complication, with one (5.3%) major complication thought to be unrelated to surgery. No open conversions were required. There was no 90-d mortality. ConclusionsOur stepwise approach can help overcome challenges of urethro-ileal anastomosis during intracorporeal neobladder formation. Patient summaryWhen performing intracorporeal neobladder formation, challenges are often encountered in fashioning the urethro-ileal anastomosis. We describe a series of maneuvers that, when used in a stepwise manner, help overcome these challenges.

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.

Robot-assisted radical cystectomy and intracorporeal neobladder formation: on the way to a standardized procedure.

BackgroundRobot-assisted radical cystectomy (RARC) with intracorporeal diversion has been shown to be feasible in a few centers of excellence worldwide, with promising functional and oncologic outcomes. However, it remains unknown whether the complexity of the procedure allows its duplication in other non-pioneer centers. We attempt to address this issue by presenting our cumulative experience with RARC and intracorporeal neobladder formation.MethodsWe retrospectively identified 62 RARCs in 50 men and 12 women (mean age 63.6 years) in two tertiary centers. Intracorporeal Studer neobladders were created, duplicating the steps of standard open surgery. Perioperative and postoperative variables and complications were analyzed using standardized tools. Functional and oncological results were assessed.ResultsThe mean operative time was 476.9 min (range, 310 to 690) and blood loss was 385 ml (200 to 800). The mean hospital stay was 16.7 (12 to 62) days with no open conversion. Perioperative complications were grade II in 15, grade III in 11, and grade IV in 5 patients. The mean nodal yield was 22.9 (8 to 46). Positive margins were found in in 6.4%. The 90- and 180-day mortality rates were 0% and 3.3%. The average follow-up was 37.3 months (3 to 52). Continence was achieved in 88% of patients. The cancer-specific survival rate and overall survival rate were 84% and 71%, respectively.ConclusionsA RARC with intracorporeal neobladder creation is safe and reproducible in ‘non-pioneer’ tertiary centers with robotic expertise with acceptable operative time and complications. Further standardization of RARC with intracorporeal diversion is a prerequisite for its widespread use.

Robot-assisted radical cystectomy and intracorporeal urinary diversion - safe and reproducible?

IntroductionRobot–assisted radical cystectomy (RARC) plus intracorporeal urinary diversion is feasible. Few centers worldwide demonstrated comparable functional and oncologic outcomes. We reported a large series of RARC and intracorporeal diversion to assess its feasibility and reproducibility.Material and methodsWe identified 101 RARCs in 82 men and 19 women (mean age 68.3 years) from October 2009 to October 2014. The patients underwent RARC and pelvic lymphadenectomy followed by intracorporeal urinary diversion (ileal conduit/ neobladder). Out of the 101 patients, 28 (27.7%) received intracorporeal ileal conduits and 73 (72.3%) intracorporeal neobladders. Studer pouch was performed in all the patients who underwent intracorporeal neobladder formation. Perioperative, functional and oncologic results including CSS and OS are reported.ResultsMean operative time was 402.3 minutes (205–690) and blood loss was 345.3 ml (50–1000). The mean hospital stay was 17.1 days (5–62). All the surgeries were completed with no open conversion. Minor complications (Grade I and II) were reported in 27.7% of patients while major complications (grade III and above) were reported in 36.6% of patients. The mean nodal yield was 20.6 (0–46). Positive ureteric margins were found in 8.9% of patients. The average follow–up was 27.5 months (1–52). Daytime continence could be achieved in 89.2% of patients who underwent intracorporeal neobladder. The 3–year cancer specific survival (CSS) and overall survival (OS) was 80.2% and 69.8% respectively.ConclusionsRARC with intracorporeal diversion is safe and reproducible in ‘non–pioneer’ tertiary centers with robotic expertise having acceptable operative time and complications as well as comparable functional and oncologic outcomes.

Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience.

Introduction:The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation.Materials and Methods:Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates.Results:The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women.Conclusions:Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.