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Robotic-assisted laparoscopic intracorporeal urinary diversion.
Raj S Pruthi1, Jeff Nix, Dan McRackan
1Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. rpruthi@med.unc.edu
European Urology
|January 19, 2010
Summary
Robotic-assisted laparoscopic radical cystectomy with intracorporeal urinary diversion shows favorable short-term outcomes. This novel procedure offers acceptable operative times and recovery for bladder cancer and dysfunction patients.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Robotic-assisted laparoscopic radical cystectomy (RALRC) is increasingly reported.
- Urinary diversion in RALRC is often extracorporeal, with limited data on intracorporeal techniques.
- This study addresses the technique and outcomes of intracorporeal urinary diversion during RALRC.
Purpose of the Study:
- To describe the stepwise technique of robotic-assisted laparoscopic intracorporeal urinary diversion.
- To evaluate the perioperative and short-term outcomes of this novel procedure.
- To compare outcomes with extracorporeal diversion methods.
Main Methods:
- A single-institution case series of 12 patients undergoing RALRC with intracorporeal urinary diversion (ileal conduit or orthotopic neobladder).
- Detailed description of the operative procedure.
- Comparison with a historical series of 20 patients undergoing RALRC with extracorporeal diversion.
Main Results:
- Mean operative time was 5.3 hours with 221ml blood loss.
- Mean time to flatus, bowel movement, and discharge was 2.2, 3.2, and 4.5 days, respectively.
- 11 of 12 patients discharged by postoperative day 5; 42% experienced complications, with one Clavien grade 3+.
Conclusions:
- Robotic-assisted intracorporeal urinary diversion demonstrates favorable initial results.
- The procedure is associated with acceptable operative and short-term clinical outcomes.
- Limitations include small sample size and nonrandomized comparison.