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Robot-sewn ileoileal anastomosis during robot-assisted cystectomy

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  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To analyze the feasibility and perioperative results of patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis.

Methods

This is a mono-centric analysis of perioperative data from 48 consecutive patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis. Data include the preoperative variables, operative and postoperative course and complication rates related to bowel anastomosis. End points were time spent for anastomosis and intra- and postoperative complication rates.

Results

Median operating time was 23.0 (13–60) min for the ileoileal anastomosis. Median overall operating time was 295 (200–780) min, with a median of 282 (200–418) min and 414.0 (225–780) min for the ileum conduit (N = 35) and ileal neobladder (N = 13). Two patients developed paralytic ileus; in another patient acute peritonitis occurred, but was caused by urinary leakage and therefore unrelated to the bowel anastomosis. No anastomotic leakage was noticed. Costs for the robot-sewn anastomosis was 8€ compared to 1250€ for a stapled anastomosis which was performed in previous cases. Limitations are the non-comparative nature of the analysis and the limited number of patients.

Conclusions

Robot-sewn ileoileal anastomosis is feasible with low complication rates. Compared to the stapled anastomosis, a robot-sewn ileoileal anastomosis may serve as an alternative and cost-saving approach.

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Funding

The study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Urology, Saarland University, Kirrbergerstr, 66421 Homburg, Germany

    P. Loertzer, S. Siemer, M. Stöckle & C. H. Ohlmann

  2. Department of Urology, Malteser Krankenhaus Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123, Bonn, Germany

    C. H. Ohlmann

Authors
  1. P. Loertzer
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  2. S. Siemer
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  3. M. Stöckle
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  4. C. H. Ohlmann
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Contributions

Loertzer: data collection, data analysis, and manuscript writing. Siemer: manuscript editing. Stöckle: manuscript editing. Ohlmann: project development, data collection, data analysis, and manuscript writing.

Corresponding author

Correspondence to C. H. Ohlmann.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this retrospective type of study formal consent is not required.

Informed consent

For this retrospective type of study informed consent was not obtained from every participant.

Electronic supplementary material

Below is the link to the electronic supplementary material.

345_2018_2237_MOESM1_ESM.tiff

Supplementary material 1 (TIFF 15211 kb). Supplementary figure. 1. Trocar positioning: one 12 mm camera-trocar above the umbilicus, two 8 mm trocars for the robotic arms 5 cm lateral of the umbilicus, an additional 8 mm robotic arm above the left anterior iliac crest. Assistant trocars consisted of a 5 mm trocar between the umbilicus and the right robotic arm and a 12 mm trocar above the right anterior iliac crest

345_2018_2237_MOESM2_ESM.tiff

Supplementary material 2 (TIFF 1521 kb). Supplementary figure. 2. Overall operating times including the initial 15 cases of intracorporeal urinary diversion with stapled and the subsequent 48 cases with robot-sewn anastomosis, including both, ileum conduit and neobladder formations. The line displays the trend in operating time of 63 cases

345_2018_2237_MOESM3_ESM.tiff

Supplementary material 3 (TIFF 1521 kb). Supplementary figure. 3. Duration of surgical time spent for the robot-sewn ileoileal anastomosis in each patient. In one patient anastomosis was performed twice for suboptimal result of the first anastomosis resulting in an overall time spent for the anastomosis of 60 min. The line displays the trend of operating time of the course of 48 patients

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Loertzer, P., Siemer, S., Stöckle, M. et al. Robot-sewn ileoileal anastomosis during robot-assisted cystectomy. World J Urol 36, 1079–1084 (2018). https://doi.org/10.1007/s00345-018-2237-3

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  • DOI: https://doi.org/10.1007/s00345-018-2237-3

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