Intracorporeal urinary diversion during robot-assisted radical cystectomy using indocyanine green

INTRODUCTION To describe the feasibility of total intracorporeal urinary diversion during robotic assisted radical cystectomy using indocyanine green (ICG) and the Firefly system of the da Vinci Xi robot and to evaluate the digestive and urinary outcomes of this technique.

After approval by the Institutional Review Board, we studied all consecutive patients who underwent robotic assisted radical cystectomy (RARC) and intracorporeal urinary derivation (ICUD) with the da Vinci Xi robot using ICG and the Firefly system, in our institution from January 1st 2018 to September 15th 2018. Pre, intra and postoperative data were analyzed with a follow up of at least 1 month.

We included 25 patients. Preoperative data were the following: 92 % were men, median age was 74 years (IQR 69-76), 64% of patients had an ASA score ≥ 3. Median operative time was 390 min (IQR 360-460). Median return to bowel function was 3 days for gas (IQR 2-5) and 5 days for stool (IQR 3-6). Median length of hospital stay was 8 days (IQR 7-10). After a median follow up of 9.6 months (IQR 8.3-12.5), only one patient (4%) presented with postoperative obstructive syndrome. There were 2 (8%) urinary leaks and 1 (4%) uretrero-enteric stricture. There were no digestive fistulas recorded. Eleven patients (44%) were readmitted within 90 days for complications.

Total intracorporeal urinary diversion during robotic assisted radical cystectomy using ICG is a feasible technique that might reduce return of bowel function and with low urinary and digestive complications.