Intracorporeal Orthotopic Ileal Neobladder Research Articles

Short-term and long-term outcomes of intracorporeal "V-O manner" ureter-ileal anastomosis in robotic-assisted laparoscopic radical cystectomy with urinary diversion: a retrospective cohort study.

There are several ways to perform ureter-ileal anastomosis (UIA), but there is currently no universally recognized standard approach. Unfortunately, these approaches may increase the risk of urine leakage or stricture. The aim of this study is we to describe an intracorporeal "V-O manner" UIA in robotic-assisted laparoscopic radical cystectomy (RARC) with urinary diversion, and to evaluate the short- and long-term patient outcomes. Between May 2012 and September 2018, 28 patients of bladder urothelial carcinomas (clinical stage T2-4aN0M0) who underwent RARC with intracorporeal urinary diversion (IUD) were included. All the patients received regular postoperative follow-up for 6-76 months. During the procedure of intracorporeal diversion, a "V-O manner" of UIA imitating the pyeloplasty in ureteropelvic junction (UPJ) obstruction was used to perform a mucosa-to-mucosa anastomosis. We observed short-term outcomes (operative time, blood loss, transfusion rate, length of hospital stay, 90-day mortality, and surgical complications) as well as long-term outcomes including kidney function and urinary diversion. Intracorporeal orthotopic ileal neobladder (OIN) was performed in 23 patients whereas intracorporeal ileal conduit (ICD) was performed in 5 patients. The "V-O manner" UIA was applied in all the cases. The average duration of bilateral UIA was about 40 min. The median pelvic lymph node yield was 26 (range, 14-43). All patients ambulated on postoperative 2 to 3 days, and bowel function recovered on postoperative day 3 to 4. The median length of hospital stay was 14 days [interquartile range (IQR), 9-18 days]. A total of 9 patients experienced complications. Postoperative images confirmed satisfying drainage of bilateral ureters without urine leakage or stricture. During the follow up (median 29 months), all participants showed normal renal functions with satisfactory urinary diversion without hydronephrosis. We describe a feasible intracorporeal "V-O manner" UIA in RARC with urinary diversion, which provides improved outcomes in avoiding urine leakage or stricture and preventing the occurrence of hydronephrosis. Larger randomized controlled trials and longer duration of follow-up needs to be required in the future.

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.

Preliminary Functional Outcome Following Robotic Intracorporeal Orthotopic Ileal Neobladder Suspension with Round Ligaments in Women with Bladder Cancer

BackgroundChronic urinary retention (CUR) is a frequent complication after orthotopic neobladder (ONB) reconstruction in women. To decrease CUR, several open surgical modifications to provide back support to the ONB have been established on the basis of pelvic anatomical differences between females and males. ObjectiveTo illustrate our technique for robotic intracorporeal reconfiguration of ONB as integrated into our open surgical approach to provide back support to the ONB with round ligaments in women. Design, setting, and participantsFrom November 2017 to April 2021, 28 patients underwent robotic intracorporeal ONB with a minimum of 6 mo of follow-up at a single centre. Surgical procedureWe performed robotic radical cystectomy, pelvic lymphadenectomy, and a complete intracorporeal ONB suspended with round ligaments (rONB). Our surgical procedure is demonstrated in the accompanying video. MeasurementsDemographics and clinical and pathological data were collected. Perioperative and 90-d complications and 6-mo functional outcomes were compared for the rONB group (n = 12) and the patients receiving a traditional ONB (tONB; n = 16). Results and limitationsThe median total operative time was 305 min (interquartile range [IQR] 270–370) for tONB and 303 min (IQR 287–330) for rONB. The median estimated blood loss was 325 ml (IQR 200–700) for tONB and 350 ml (IQR 262–600) for rONB. Some 50% of the tONB group and 41.7% of the rONB group experienced low-grade complications. A total of 12.5% tONB and 8.3% rONB patients experienced high-grade complications with neobladder-vaginal fistula. The cumulative risk of CUR was 37.5% in the tONB group and 16.7% in the rONB group. This study is limited by the small sample size and the short follow-up period. ConclusionsWe established a feasible surgical technique for a robotic intracorporeal ONB configuration suspended with round ligaments. This may prevent the occurrence of emptying dysfunction in women. Patient summaryWe describe our stepwise technique for creating a new bladder within the body that is suspended with round ligaments. Patients undergoing removal of the bladder for bladder cancer may benefit from this technique in terms of better urinary function and the advantages of a robotic surgical approach.

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 ...

P092 - Analysis of techniques, perioperative, functional and survival outcomes after robot assisted radical cystectomy and intracorporeal orthotopic ileal neobladder: Our experience

P092 - Analysis of techniques, perioperative, functional and survival outcomes after robot assisted radical cystectomy and intracorporeal orthotopic ileal neobladder: Our experience

Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step.

A posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified posterior Rocco's repair involving the Denonvillier's fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck was performed. The steps are shown in a video at https://doi.org/10.1089/vid.2019.0029 . The primary outcome was urinary continence; the secondary outcomes were urinary leakage, intermittent catheterization, and complications related to the reconstructive steps. Eleven male patients with a median age and BMI of 67years and 24, respectively, underwent RARC with PR associated to the neovesico-urethral anastomosis. Overall and posterior reconstruction time were 300' (195-320) and 6' (4-7), respectively. The daytime and nighttime continence rates were 100% and 44% at 12months, respectively; the median pad weight was 3.5g and 108g at daytime and nighttime, respectively. One urinary leakage from the urethrovesical anastomosis was treated conservatively. Two patients perform intermittent catheterization. The posterior reconstruction during RARC is safe and feasible, providing good continence rates. It supported a careful suturing of the anastomosis as well as an uncomplicated catheter placement.

Posterior Reconstruction During Robot-Assisted Radical Cystectomy with Intracorporeal Orthotopic Ileal Neobladder

Abstract Introduction: To assess the feasibility and functional outcomes of posterior reconstruction (PR) during robot-assisted radical cystectomy (RARC) with neobladder. Materials and Methods: The...

Female robotic-assisted laparoscopic radical cystectomy with intracorporeal orthotopic W-shaped ileal neobladder

Objective To report the technique and effect of robotic-assisted laparoscopic radical cystectomy (RARC) totally intracorporeal orthotopic ileal neobladder in female bladder cancer patient. Methods A consecutive series of 5 female patients with urothelial carcinoma of the bladder, who underwent RARC, bilateral pelvic lymph node dissection and intracorporeal orthotopic W-shaped ileal neobladder by an experienced robotic surgeon, were included in the retrospective study, from December 2017 to March 2018. Data were reviewed retrospectively. The patients aged 51-68 years old, with mean age 62.2 years, and BMI was 13.6-22.8 kg/m2, mean 18.1 kg/m2. The specimens were removed from the vagina. A 40 cm bowel segment with detubularisation was chosen for the W-shaped neobladder which was constructed manually. All patients resumed ambulation on postoperative 2 days and resumed oral feeding on postoperative day 3. The single-J stents and catheter were removed 12 days and 2 weeks after operation, respectively. Results All operation were performed successfully. The average operation time was 384.2 min (ranging 355-428 min) with mean estimated blood loss of 620 ml (ranging 150-1 800 ml). And the average number of dissected lymph nodes was 15 (ranging 10-20). The neobladder and urethra anastomotic leakage was observed in one patient who was healed after 2 weeks indwell catheter. Small bowel obstruction occurred in one case 3 weeks after operation and recovered after conservative treatment. The daytime urinary control was good, and 1 cases had urinary incontinence at night (follow up 4-7months, median: 5.5months). No recurrence or metastasis was observed during routine follow-up. The imaging showed the good morphology of the upper urinary tract and the new bladder. Conclusions Our initial experience supports the feasibility and advantage of totally intracorporeal orthotopic W-shaped ileal neobladder following RARC in female patient with bladder cancer. It is worth to further verification in a large sample with longer follow-up. Key words: Bladder neoplasms; Female; Robot; Radical cystectomy; Intracorporeal orthotopic ileal neobladder

Comparison of perioperative outcomes and complications between intracorporeal and extracorporeal orthotopic ileal neobladder after laparoscopic radical cystectomy

Objective To compare perioperative outcomes and complications between intracorporeal and extracorporeal orthotopic ileal neobladder after laparoscopic radical cystectomy (LRC) from one center. Methods We retrospectively analysis patients’ clinical and follow-up data who underwent laparoscopic radical cystectomy (LRC) in our hospital from January 2011 to May 2017, of whom 25 cases underwent intracorporeal orthotopic ileal neobladder (ICIN) and 20 cases underwent extracorporeal orthotopic ileal neobladder (ECIN). The patients' characteristics, perioperative data, postoperative pathological results, postoperative complications and oncologic outcomes were compared and analyzed. The mean age of ECIN group was (59.9±10.5)years, mean BMI was (24.7±3.3)kg/m2, the ASA level was less than Ⅱ in 19 cases and level Ⅲ in 1 case, the mean preoperative CCI was 4.5±1.6, 3 patients got preoperative neoadjuvant chemotherapy. The mean age of ICIN group was (59.0±9.8)years, mean BMI was (25.3±4.3)kg/m2, the ASA level was less than Ⅱ in 25 cases and no level Ⅲ, mean preoperative CCI was 4.0±1.3, 3 patients got preoperative neoadjuvant chemotherapy. There was no statistical difference between the two groups in patients' characteristics. All operations were performed under general anesthesia.After LRC was accomplished, an additional 12 mm trocar was placed 1 cm crania to the pubic symphysis for EndoGIA in ICIN group. An ileal segment 60 cm long was isolated 25 cm proximal to the ileocecum. The continuity of the small bowel was restored with side to side anastomosis. The proximal 10 cm was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb. Then, the remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border. The anterior wall of the neobladder was folded forward and the free edges were sutured to achieve a spherical configuration. After single J ureteric stents were inserted into the ureters, the urethra and ureters were sutured with neobladder successively. For ECIN, the ileal segment is removed via a midline laparotomy below the umbilicus 5-10 cm. The construction method of neobladder was the same with ICIN group. Results All 45 cases were successfully operated. There was no statistical difference between ICIN group and ECIN group in operation time [(374.2±74.6)min vs.(360.3±83.6)min, P=0.557] and extraction time of pelvic drainage tube[(12.5±5.9)d vs.(11.8±4.5)d, P=0.686]. Patients in the ICIN group had less intraoperative blood loss [(186.0±140.3)ml vs. (272.0±110.7)ml, P=0.030], shorter oral intake time [(4.2±2.2)d vs.(6.1±1.6)d, P=0.002], shorter postoperative hospital stay [(13.7±4.2)d vs.(19.9+ 7.6)d, P=0.001]. There was no significant difference in the early postoperative complications (P=0.345). The median follow-up time of ICIN group and ECIN group were 30 months and 52.5 months, respectively. The day-time and night-time continence rate were 97.4% and 86.8% respectively in the first year after surgery without significant difference. A total of 6 patients suffered distant metastasis, of whom 4 patients suffered multiple metastases, 1 case bone metastases and 1 case pelvic lymph node metastasis. Seven patients died, five of whom died of tumor recurrence or metastasis. There was no statistical difference between the two groups in cancer specific survival rates (P=0.644) and recurrence free survival rates (P=0.981). Conclusions Comparing with extracorporeal orthotopic ileal neobladder, intracorporeal orthotopic ileal neobladder has advantages of less blood loss and faster intestinal function recovery, without significantly increased operative time and complications. No significant difference was found in the function of neobladder and oncological outcomes. Randomized controlled trial with large sample and long-term follow-up is needed to verify the advantages of intracorporeal neobladder construction. Key words: Bladder cancer; Laparoscopy; Radical cystectomy; Orthotopic ileal neobladder

Contemporary techniques and outcomes of robotic cystectomy and intracorporeal urinary diversions.

Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is being increasingly performed worldwide. This review summarizes recent technical developments and outcome data for RARC with ICUD. With the recent description of intracorporeal continent cutaneous diversion, all classes of urinary diversion can presently be performed totally intracorporeally. The summary of our seven cases of intracorporeal continent cutaneous diversion in this article brings the number of reported cases in the literature to 17. Additional recent advancements in ICUD focus on novel technical descriptions and outcome data. Several intracorporeal orthotopic ileal neobladder techniques have been described with intermediate perioperative outcomes. There is some rationale for reduced overall, wound, gastrointestinal and genitourinary complications with ICUD. RARC with intracorporeal diversion is a feasible option for patients with bladder cancer. Prospective and randomized outcome data are needed to better characterize the benefit of ICUD in patients following radical cystectomy.

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.

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

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

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.

AB172. Laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs: initial experience

ObjectiveTo describe the surgical technique and initial experience of laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs.MethodsFrom January 2014 to December 2015, 13 patients who underwent a new method of orthotopic ileal neobladder intracorporeally after laparoscopic radical cystectomy were retrospectively reviewed at our institution. To construct the neobladder, an ileal segment 60 cm long was isolated approximate 25 cm proximally to the ileocecum. The proximal 20 cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10 cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border for the reservoir. The demographics, perioperative and follow-up data were analyzed for the study.ResultsAll procedures were successfully performed without open conversion. The mean operative time was 372 minutes (range, 280–470 minutes), and mean neobladder construction time was 229 minutes (range, 180–298 minutes). The mean estimated blood loss was 150 mL (range, 100–400 mL). The mean time to flatus was 4 days (range, 3–12 days). No major complications occurred within 30 days.ConclusionsLaparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs is safe and feasible. However, larger series with long term follow-up are required to prove its superiority.

AB014. Laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs: initial experience.

ObjectiveTo describe the surgical technique and initial experience of laparoscopic radical cystectomy and intracorporeal orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs.Materials and MethodsFrom January 2014 to Jun 2015, 11 patients underwent a new method of orthotopic ileal neobladder intracorporeally after laparoscopic radical cystectomy at our institution. To construct the neobladder, an ileal segment 60 cm long was isolated approximate 25 cm proximally to the ileocecum. The proximal 20 cm of the ileal segment was divided into 2 parts for bilateral isoperistaltic afferent limbs. The proximal 10 cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10 cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40 cm ileal segment was detubularized along its antimesenteric border for the reservoir. The demographics, perioperative and follow-up data were analyzed for the study.ResultsAll surgeries were successfully performed without open conversion. The mean operative time was 365 minutes, and mean neobladder construction time was 246 minutes. The mean estimated blood loss was 190 mL. The mean time to flatus was 4 days. Postoperative complications occurred in 4 patients, including 2 cases of incomplete bowel obstruction, 1 case of urinary tract infection, and 1 case of incision hernia.ConclusionsLaparoscopic radical cystectomy with the novel urinary diversion is safe, feasible and reproducible with encouraging outcomes. Larger series with long term follow-up are required to prove its superiority.

Videourodynamic Evaluation of Intracorporeally Reconstructed Orthotopic U-shaped Ileal Neobladders

To study the functional outcomes of 30 patients who had previously undergone laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder reconstruction using videourodynamic (VUDM) assessment 180days postoperatively. Between November 2010 and December 2013, 30 male patients had undergone laparoscopic radical cystectomy with bilateral standard pelvic lymphadenectomy and pure laparoscopic orthotopic ileal U-shaped neobladder diversion. The demographic data were as follows: median age, 67years (range, 62-79); body mass index, 22.3 kg/m(2) (range, 16-26.1 kg/m(2)); and mean American Society of Anesthesiologists score 2.2 (range, 1-3). Functional outcomes were assessed performing a standard VUDM study combined with perineal floor electromyography 180days postoperatively. VUDM evaluations showed good functional outcomes of the reservoirs. Mean maximal neobladder capacity was 287mL (range, 210-335mL). Residual peristaltic activity was observed in all the individuals evaluated; however, only 9 of 30 individuals (30%) displayed severe peristaltic activity. Six of these 9 individuals (66.6%) experienced urinary leakage during these contractions. Mean postvoid residual volume was 44mL (range, 0-105mL), and peak flow rate was 13.9mL/s (range, 9.7-29.2mL/s). The Valsalva maneuver was positive in 5 of 30 subjects (17%). Bladder morphology assessed during contrast cystography showed the desired U-shape in all cases. Ureteral reflux was observed in 7 of 30 individuals (23.3%). Based on VUDM, our study shows that U-shaped ileal neobladders achieved by a totally laparoscopic approach obtained good functional outcomes. These findings support the evidence that a minimally invasive approach does not impose technical limitations that negatively impact the surgical results.

Laparoscopic Radical Cystectomy With Intracorporeal Orthotopic Ileal Neobladder: Technique and Clinical Outcomes

To study the feasibility and safety of laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder and to evaluate the role of endoscopic stapling in neobladder construction. Fifty-five patients with bladder cancer who underwent laparoscopic radical cystectomy were retrospectively examined. Extended pelvic lymph node dissection was performed before cystectomy. An ileal segment of 50cm was harvested to construct a U-shaped reservoir. The bottom of the reservoir was anastomosed with the posterior urethra. Twenty-five patients underwent neobladder construction by manual suturing and 30 patients by endoscopic stapler suturing. The mean operative time was 346minutes, and mean neobladder construction time was 230minutes. The median estimated blood loss was 500mL, and 17 patients received intraoperative transfusion. Postoperative complications included 2 cases of urine leakage, 7 cases of pyelonephritis, 4 cases of incomplete bowel obstruction, 1 case of anastomotic stricture, and 1 case of death. Endoscopic stapler suturing for neobladder construction took significantly less time than manual suturing. However, neobladder stones were found in 2 patients who underwent operation using endoscopic suturing, and the stones were removed cystoscopically. The functional outcomes of the 2 constructive methods were comparable. Laparoscopic radical cystectomy with intracorporeal orthotopic neobladder is safe and feasible for experienced laparoscopic surgeons. Application of endoscopic stapler simplifies the surgical procedure while increasing the risk of neobladder stone formation.

Pure intracorporeal laparoscopic radical cystectomy with orthotopic "U" shaped ileal neobladder.

BackgroundRadical cystectomy with pelvic lymph node dissection represents the standard treatment for muscle-invasive, and high-risk non-muscle-invasive bladder cancers. Aim of this study was to report our case series of 30 patients undergoing totally laparoscopic radical cystectomy (LRC) with reconstruction of an intracorporeal orthotopic ileal neobladder. Intra- and perioperative results and the functional and oncological outcomes 9 months after operation are reported.MethodsBetween October 2010 and December 2012, 30 male patients underwent LRC with a pure laparoscopic orthotopic ileal “U”- shaped neobladder diversion. The men had a median age of 67 years, a median body mass index of 22.3, and a mean ASA score of 2.2; they represented various clinical stages of disease.ResultsNone of the patients required conversion to open surgery, and no perioperative mortalities were reported. The median operating time was 365 min, and the median blood loss was 290 mL, with a transfusion rate of 26.6%. All surgical margins were negative; 8 patients with non–organ-confined disease or positive lymph nodes received adjuvant chemotherapy. Early complications (within 30 days) occurred in 7 patients, and late complications occurred in 6 patients. The mean hospital stay was 9 days. At 9 months after surgery, the daytime continence rate was 83.3% and the nighttime continence rate was 73.3%.ConclusionsPure LRC with intracorporeal orthotopic ileal neobladder reconstruction may represent a viable alternative to open radical cystectomy, with a significant reduction in patient morbidity. Future, large, randomized controlled trials with extensive follow-up are needed to confirm our encouraging results.

Robotic Radical Cystectomy—Is the Diversion the Achilles' Heel?

No AccessJournal of UrologyOpposing Views1 Dec 2014Robotic Radical Cystectomy—Is the Diversion the Achilles' Heel? Richard E. Hautmann, Harry W. Herr, Raj S. Pruthi, and Monish Aron Richard E. HautmannRichard E. Hautmann More articles by this author , Harry W. HerrHarry W. Herr More articles by this author , Raj S. PruthiRaj S. Pruthi More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.09.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol2014; . Epub ahead of print. Google Scholar 2 : A randomized trial of robot-assisted laparoscopic radical cystectomy. New Engl J Med2014; 371: 389. Google Scholar 3 : Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol1988; 139: 519. Link, Google Scholar 4 : Surgery in motion: robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol2010; 57: 1013. Google Scholar 5 : Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int2011; 110: 434. Google Scholar 6 : Oncologic, functional, and complications outcomes of robotic-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol2013; 64: 734. Google Scholar 7 : Laparoscopic-assisted radical cystectomy with U-shaped orthotopic ileal neobladder constructed using nonabsorbable titanium staples. Urology2006; 68: 193. Google Scholar 8 : The ileal neobladder: experience and results of more than 100 consecutive cases. J Urol1990; 143: 492. Abstract, Google Scholar 9 : Orthotopic bladder substitution in men. revisited: identification of continence predictors. J Urol2006; 176: 2081. Link, Google Scholar 10 : Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol2012; 62: 891. Google Scholar 11 : Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int2003; 92: 232. Google Scholar 12 : Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol2010; 57: 196. Google Scholar 13 : Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol2013; 189: 474. Link, Google Scholar 14 : Robotic intracorporeal urinary diversion: ileal conduit. J Endourol2012; 26: 1566. Google Scholar 15 : The first 100 consecutive, robot-assisted, intracorporeal ileal conduits: evolution of technique and 90-day outcomes. Eur Urol2013; 63: 637. Google Scholar 16 : Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. J Urol2014; 192: 1734. Link, Google Scholar 17 : Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol2014; 65: 340. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHautmann R (2017) Declining Use of Orthotopic Reconstruction Worldwide—What Went Wrong?Journal of Urology, VOL. 199, NO. 4, (900-903), Online publication date: 1-Apr-2018.Hautmann R (2016) Editorial CommentJournal of Urology, VOL. 196, NO. 5, (1556-1557), Online publication date: 1-Nov-2016. Volume 192Issue 6December 2014Page: 1601-1603 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard E. Hautmann More articles by this author Harry W. Herr More articles by this author Raj S. Pruthi More articles by this author Monish Aron More articles by this author Expand All Advertisement PDF downloadLoading ...

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.