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Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step

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Abstract

A posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified posterior Rocco’s repair involving the Denonvillier’s fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck was performed. The steps are shown in a video at https://doi.org/10.1089/vid.2019.0029. The primary outcome was urinary continence; the secondary outcomes were urinary leakage, intermittent catheterization, and complications related to the reconstructive steps. Eleven male patients with a median age and BMI of 67 years and 24, respectively, underwent RARC with PR associated to the neovesico-urethral anastomosis. Overall and posterior reconstruction time were 300′ (195–320) and 6′ (4–7), respectively. The daytime and nighttime continence rates were 100% and 44% at 12 months, respectively; the median pad weight was 3.5 g and 108 g at daytime and nighttime, respectively. One urinary leakage from the urethrovesical anastomosis was treated conservatively. Two patients perform intermittent catheterization. The posterior reconstruction during RARC is safe and feasible, providing good continence rates. It supported a careful suturing of the anastomosis as well as an uncomplicated catheter placement.

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Authors and Affiliations

  1. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    Bernardo Rocco

  2. Department of Urology, S. Chiara Regional Hospital, L.Go Medaglie d’Oro, 38122, Trento, Italy

    Lorenzo G. Luciani & Daniele Mattevi

  3. Department of Urology, Karolinska University Hospital, Stockholm, Sweden

    Justin Collins, Rodolfo Sanchez-Salas, Christofer Adding, Abolfazl Hosseini & Peter Wiklund

  4. Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA

    Peter Wiklund

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  1. Bernardo Rocco
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  2. Lorenzo G. Luciani
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  3. Justin Collins
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  4. Rodolfo Sanchez-Salas
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  5. Christofer Adding
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  6. Daniele Mattevi
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  7. Abolfazl Hosseini
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  8. Peter Wiklund
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Correspondence to Lorenzo G. Luciani.

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Rocco, B., Luciani, L.G., Collins, J. et al. Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step. J Robotic Surg 15, 355–361 (2021). https://doi.org/10.1007/s11701-020-01108-0

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  • DOI: https://doi.org/10.1007/s11701-020-01108-0

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