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Robotic intracorporeal urinary diversion: technical details to improve time efficiency
Mihir M Desai1, Andre Luis Castro de Abreu, Alvin C Goh
1Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California , Los Angeles, California.
Journal of Endourology
|June 14, 2014
Summary
Robotic radical cystectomy with intracorporeal urinary diversion is safe and efficient, even for surgeons early in the learning curve. This study presents time-efficiency data and technical tips for this complex procedure.
Area of Science:
- Urology
- Robotic Surgery
- Surgical Oncology
Background:
- Robotic radical cystectomy is a standard treatment for bladder cancer.
- Intracorporeal urinary diversion (ICUD) offers potential benefits but requires a learning curve.
- Optimizing operative time is crucial for widespread adoption of ICUD.
Purpose of the Study:
- To evaluate time-efficiency during the initial experience with robotic radical cystectomy and ICUD.
- To identify technical tips to shorten operative time during the learning curve.
- To present data on safety and reproducibility of ICUD.
Main Methods:
- Analysis of operative time data from 37 consecutive patients undergoing robotic radical cystectomy and ICUD.
- Stepwise recording of operative time for each component of the procedure.
- Prospective collection of peri-operative, follow-up, and pathological data.
Main Results:
- All 37 procedures were completed intracorporeally without conversion.
- Median total operative time was similar for orthotopic neobladder and ileal conduit.
- Median diversion time was 111 minutes (ileal conduit 92, neobladder 124).
- 1-year recurrence-free and overall survival rates were 64% and 70%, respectively.
Conclusions:
- Intracorporeal urinary diversion can be safely performed robotically.
- The procedure is reproducible and time-efficient, even early in the learning curve.
- Technical optimization can further improve efficiency.
