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

G. Simone, R. Papalia, L. Misuraca, G. Tuderti, F. Minisola, M. Ferriero, G. Vallati, S. Guaglianone, M. Gallucci

Research output: Contribution to journalArticle

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 305min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210ml (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.
Original languageEnglish
Pages (from-to)934-940
Number of pages7
JournalEuropean Urology
Volume73
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

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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

Cite this

Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. / Simone, G.; Papalia, R.; Misuraca, L.; Tuderti, G.; Minisola, F.; Ferriero, M.; Vallati, G.; Guaglianone, S.; Gallucci, M.

In: European Urology, Vol. 73, No. 6, 01.06.2018, p. 934-940.

Research output: Contribution to journalArticle

Simone, G. ; Papalia, R. ; Misuraca, L. ; Tuderti, G. ; Minisola, F. ; Ferriero, M. ; Vallati, G. ; Guaglianone, S. ; Gallucci, M. / Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. In: European Urology. 2018 ; Vol. 73, No. 6. pp. 934-940.
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T1 - Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

AU - Simone, G.

AU - Papalia, R.

AU - Misuraca, L.

AU - Tuderti, G.

AU - Minisola, F.

AU - Ferriero, M.

AU - Vallati, G.

AU - Guaglianone, S.

AU - Gallucci, M.

N1 - LR: 20180519; CI: Copyright (c) 2016; JID: 7512719; CIN: Transl Androl Urol. 2017 Dec;6(6):1187-1189. PMID: 29354509; OTO: NOTNLM; 2016/08/29 00:00 [received]; 2016/10/11 00:00 [accepted]; 2016/10/27 06:00 [pubmed]; 2016/10/27 06:00 [medline]; 2016/10/27 06:00 [entrez]; ppublish

PY - 2018/6/1

Y1 - 2018/6/1

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 305min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210ml (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.

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 305min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210ml (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.

KW - Bladder cancer

KW - Intracorporeal urinary diversion

KW - Orthotopic neobladder

KW - Padua ileal bladder

KW - Radical cystectomy

KW - Robotic intracorporeal neobladder

KW - Robotic surgery

U2 - S0302-2838(16)30721-7 [pii]

DO - S0302-2838(16)30721-7 [pii]

M3 - Article

VL - 73

SP - 934

EP - 940

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -