Tips and Tricks for Intracorporeal Robot-Assisted Urinary Diversion
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Since 2003, Karolinska University Hospitals have performed totally intracorporeal robotic-assisted radical cystectomy (RARC) in carefully selected patients. As our technique has evolved, the proportion of patients undergoing RARC has progressively increased. Whilst open radical cystectomy remains the gold standard, several high-volume centres have now demonstrated that RARC is both feasible and safe. RARC comprises three stages: radical cystectomy, extended lymph node dissection and urinary diversion. The majority of centres in the United States currently perform RARC utilizing an extracorporeal approach for the urinary diversion stage, perceiving this to be a more accessible option with a reduced risk of complications. We assess the evidence for this perception, reviewing the literature and reporting the functional outcomes and complication rates for a totally intracorporeal RARC approach. We also describe our technique for both intracorporeal orthotopic neobladder and intracorporeal ileal conduit, identifying the potential hazard steps and the ‘tips and tricks’ to optimize outcomes.
KeywordsRobotic cystectomy Totally intracorporeal Intracorporeal diversion Ileal conduit Orthotopic neobladder Bladder cancer
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Justin W. Collins, Dr. Abolfazl. Hosseini, P. Dr. P. Sooriakumaran, T. Dr. T. Nyberg, R. Dr. R. Sanchez-Salas, Dr. C. Adding, Dr. Martin C. Schumacher, and Dr. N. Peter Wiklund each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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