Updates on Robotic Intracorporeal Urinary Diversions

More than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery.

In this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles. Several potential benefits of intracorporeal urinary diversion are being investigated-such as a reduction in gastrointestinal complications, ureteral strictures, and wound complications. Finally, we highlight the important aspects of establishing an intracorporeal urinary diversion program integrated with an Enhanced Recovery after Surgery (ERAS) program. We have included the perioperative outcomes of 100 consecutive cases of intracorporeal urinary diversion with an Enhanced Recovery after Surgery (ERAS) protocol. In this series, 49% were continent diversions. Patients had a median length of stay of 5 days, with 37% staying 4 days or less. High-grade complications and readmissions were noted in 22 and 20% of patients, respectively. The benefits of intracorporeal urinary diversion appear promising, and there is continued need for high-quality randomized controlled trials to define its role in patients undergoing radical cystectomy.