Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Giuseppe Simone, Rocco Papalia, Leonardo Misuraca, Gabriele Tuderti, Francesco Minisola, Mariaconsiglia Ferriero, Giulio Vallati, Salvatore Guaglianone, Michele Gallucci

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility. Objective: To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder. Design, setting, and participants: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre. Surgical procedure: RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video. Measurements: Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported. Results and limitations: Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305. min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210. ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results. Conclusions: Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience. Patient summary: We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres. Our experience supports the feasibility of totally-intracorporeal neobladder following robotic radical cystectomy. Robotic intracorporeal Padua ileal bladder is a safe surgical option in tertiary referral centres. Operative times and perioperative complication rates are likely to be reduced with increasing experience.

Original languageEnglish
JournalEuropean Urology
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Cystectomy
Robotics
Urinary Bladder
Operative Time
Tertiary Care Centers
Conversion to Open Surgery
Lymph Node Excision
Reproducibility of Results
Sample Size
Disease-Free Survival
Length of Stay
Survival Rate
Demography
Survival
Incidence
Neoplasms

Keywords

  • Bladder cancer
  • Intracorporeal urinary diversion
  • Orthotopic neobladder
  • Padua ileal bladder
  • Radical cystectomy
  • Robotic intracorporeal neobladder
  • Robotic surgery

ASJC Scopus subject areas

  • Urology

Cite this

Robotic Intracorporeal Padua Ileal Bladder : Surgical Technique, Perioperative, Oncologic and Functional Outcomes. / Simone, Giuseppe; Papalia, Rocco; Misuraca, Leonardo; Tuderti, Gabriele; Minisola, Francesco; Ferriero, Mariaconsiglia; Vallati, Giulio; Guaglianone, Salvatore; Gallucci, Michele.

In: European Urology, 2016.

Research output: Contribution to journalArticle

Simone, Giuseppe ; Papalia, Rocco ; Misuraca, Leonardo ; Tuderti, Gabriele ; Minisola, Francesco ; Ferriero, Mariaconsiglia ; Vallati, Giulio ; Guaglianone, Salvatore ; Gallucci, Michele. / Robotic Intracorporeal Padua Ileal Bladder : Surgical Technique, Perioperative, Oncologic and Functional Outcomes. In: European Urology. 2016.
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abstract = "Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility. Objective: To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder. Design, setting, and participants: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre. Surgical procedure: RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video. Measurements: Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported. Results and limitations: Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305. min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210. ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4{\%}, 57.8{\%}, and 77.8{\%}, respectively, while severe complications occurred in17.8{\%}, 17.8{\%}, and 35.5{\%}, respectively. Two-yr daytime and night-time continence rates were 73.3{\%} and 55.5{\%}, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5{\%}, 82.3{\%}, and 82.4{\%}, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results. Conclusions: Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience. Patient summary: We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres. Our experience supports the feasibility of totally-intracorporeal neobladder following robotic radical cystectomy. Robotic intracorporeal Padua ileal bladder is a safe surgical option in tertiary referral centres. Operative times and perioperative complication rates are likely to be reduced with increasing experience.",
keywords = "Bladder cancer, Intracorporeal urinary diversion, Orthotopic neobladder, Padua ileal bladder, Radical cystectomy, Robotic intracorporeal neobladder, Robotic surgery",
author = "Giuseppe Simone and Rocco Papalia and Leonardo Misuraca and Gabriele Tuderti and Francesco Minisola and Mariaconsiglia Ferriero and Giulio Vallati and Salvatore Guaglianone and Michele Gallucci",
year = "2016",
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language = "English",
journal = "European Urology",
issn = "0302-2838",
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TY - JOUR

T1 - Robotic Intracorporeal Padua Ileal Bladder

T2 - Surgical Technique, Perioperative, Oncologic and Functional Outcomes

AU - Simone, Giuseppe

AU - Papalia, Rocco

AU - Misuraca, Leonardo

AU - Tuderti, Gabriele

AU - Minisola, Francesco

AU - Ferriero, Mariaconsiglia

AU - Vallati, Giulio

AU - Guaglianone, Salvatore

AU - Gallucci, Michele

PY - 2016

Y1 - 2016

N2 - Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility. Objective: To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder. Design, setting, and participants: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre. Surgical procedure: RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video. Measurements: Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported. Results and limitations: Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305. min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210. ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results. Conclusions: Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience. Patient summary: We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres. Our experience supports the feasibility of totally-intracorporeal neobladder following robotic radical cystectomy. Robotic intracorporeal Padua ileal bladder is a safe surgical option in tertiary referral centres. Operative times and perioperative complication rates are likely to be reduced with increasing experience.

AB - Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility. Objective: To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder. Design, setting, and participants: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre. Surgical procedure: RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video. Measurements: Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported. Results and limitations: Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305. min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210. ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results. Conclusions: Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience. Patient summary: We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres. Our experience supports the feasibility of totally-intracorporeal neobladder following robotic radical cystectomy. Robotic intracorporeal Padua ileal bladder is a safe surgical option in tertiary referral centres. Operative times and perioperative complication rates are likely to be reduced with increasing experience.

KW - Bladder cancer

KW - Intracorporeal urinary diversion

KW - Orthotopic neobladder

KW - Padua ileal bladder

KW - Radical cystectomy

KW - Robotic intracorporeal neobladder

KW - Robotic surgery

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