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Comprehensive 90-Day Morbidity Assessment Following Robot-Assisted Radical Cystectomy With Intracorporeal Diversion.

Anas Elyan1, Laura Wimmer1, Jan Ebbing1

  • 1Department of Urology, University Hospital of Basel, Basel, Switzerland, unispital-basel.ch.

Advances in Urology
|April 23, 2026
PubMed
Summary

Robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) is feasible with an acceptable safety profile. Most complications were systemic, emphasizing the need for multidisciplinary perioperative care and detailed patient counseling.

Keywords:
Clavien–Dindo classificationenhanced recovery after surgery (ERAS)intracorporeal urinary diversion (ICUD)perioperative complicationsrobot-assisted radical cystectomy (RARC)systemic vs. surgical morbidityureteral stricture

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Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) is an evolving minimally invasive technique for bladder cancer treatment.
  • Transitioning from open surgery to iRARC requires careful evaluation of perioperative morbidity and complication profiles.

Purpose of the Study:

  • To assess perioperative morbidity following iRARC during the initial learning curve at a single academic center.
  • To provide detailed complication profiles to guide surgical teams and patient counseling.

Main Methods:

  • Retrospective analysis of 111 consecutive patients undergoing iRARC between 2017 and 2023.
  • Complications assessed at 30 and 90 days using Clavien-Dindo classification, categorized by etiology and severity.
  • Detailed incidence rates and management strategies were recorded.

Main Results:

  • 163 complications occurred within 90 days (129 within 30 days), with 74% being low-grade.
  • Systemic complications (84%) outnumbered surgical events (16%). Common high-grade early complications included cardiovascular, respiratory, infectious, and genitourinary events.
  • High rates of urinary tract infections (32.4%) and infected lymphoceles (8.1%) were observed. 90-day mortality was 1.8%.

Conclusions:

  • iRARC demonstrates feasibility with an acceptable safety profile during the learning curve.
  • The majority of complications are systemic, highlighting the importance of multidisciplinary perioperative management.
  • Detailed complication data aids realistic patient counseling and enhances care team awareness.