Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Perioperative Management and Operative...

Radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive bladder cancer and selected high-risk non-muscle-invasive disease. The procedure carries substantial morbidity, in part because the typical patient is elderly and burdened by cardiorespiratory comorbidity. Robot-assisted radical cystectomy (RARC) was developed to attenuate this morbidity, and RARC with intracorporeal urinary diversion (iRARC) avoids the laparotomy that earlier randomized trials required for extracorporeal reconstruction. In this technical narrative review, we present a single-institution operative approach to iRARC, distinguishing institutional practice from evidence-based recommendations. We describe patient selection, preoperative optimization and enhanced recovery, and provide a step-by-step account of our operative technique for male and female radical cystectomy, pelvic lymph node dissection template, and totally intracorporeal ileal conduit and orthotopic neobladder reconstruction. We also summarize the perioperative, oncological, and functional outcomes of iRARC, which support its role as a safe option with specific perioperative advantages in experienced, high-volume centers.