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Robot-Assisted Radical Cystectomy: Technical Tips for Totally Intracorporeal Urinary Diversion

  • Seok Ho KangEmail author
  • Ji Sung Shim
Chapter

Abstract

Robot-assisted radical cystectomy (RARC) has emerged as an equivalent approach to open radical cystectomy (RC) with potentially equivalent oncological outcomes. Whether urinary diversion (UD) during RARC is best completed extracorporeally or intracorporeally remains a debatable topic among clinicians. The UD procedure could constitute a more significant factor associated with postoperative morbidity and complications than the actual cystectomy itself. Following the introduction of minimally invasive techniques used to perform a cystectomy, extracorporeal urinary diversion (ECUD) is widely accepted as a more efficient and safe method, and most RARC procedures in the United States are performed through an ECUD.

Most case reports describing RARC indicate the use of ECUD owing to perceived difficulties with intracorporeal bowel reconstruction (ICUD) and concerns about time efficiency compared to open surgery. However, a total ICUD approach could be considered a possible alternative to maximize the advantages of minimally invasive surgery. It is known that ICUD minimizes evaporative fluid loss, decreases estimated blood loss, reduces the risk of fluid imbalance, and pain, and rapidly restores bowel function. Despite there are potential perioperative benefits, ICUD has been criticized due to doubts regarding the ability to perform this procedure routinely during surgery and its benefits to patients without further increasing the rate of complications.

We adduce a step-wise description of our RARC technique with bilateral PLND and UD that adheres to the established dimensions and configuration of the Studer neobladder.

Keywords

Bladder cancer Radical cystectomy Robotic surgical procedures Urinary diversion 

References

  1. Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340–7.PubMedGoogle Scholar
  2. Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67(6):1042–50.PubMedGoogle Scholar
  3. Canda AE, Atmaca AF, Altinova S, Akbulut Z, Balbay MD. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int. 2012;110(3):434–44.PubMedGoogle Scholar
  4. Carter JJ, Whelan RL. The immunologic consequences of laparoscopy in oncology. Surg Oncol Clin N Am. 2001;10(3):655–77. Epub 2001/11/01. engPubMedGoogle Scholar
  5. Chan KG, Guru K, Wiklund P, et al. Robot-assisted radical cystectomy and urinary diversion: technical recommendations from the Pasadena Consensus Panel. Eur Urol. 2015;67(3):423–31.PubMedGoogle Scholar
  6. Collins JW, Sooriakumaran P, Sanchez-Salas R, et al. Robot-assisted radical cystectomy with intracorporeal neobladder diversion: the Karolinska experience. Indian J Urol. 2014a;30(3):307–13. Epub 2014/08/07. engPubMedPubMedCentralGoogle Scholar
  7. Collins JW, Tyritzis S, Nyberg T, et al. Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder—what is the effect of the learning curve on outcomes? BJU Int. 2014b;113(1):100–7.PubMedGoogle Scholar
  8. Collins JW, Wiklund NP. Totally intracorporeal robot-assisted radical cystectomy: optimizing total outcomes. BJU Int. 2014;114(3):326–33.PubMedGoogle Scholar
  9. Collins JW, Wiklund PN, Desai MM, Goh AC, Gill IS. Total intracorporeal robotic cystectomy: are we there yet? Curr Opin Urol. 2013;23(2):135–40.PubMedGoogle Scholar
  10. Daneshmand S, Ahmadi H, Schuckman AK, et al. Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol. 2014;192(1):50–6.PubMedGoogle Scholar
  11. Goh AC, Gill IS, Lee DJ, et al. Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol. 2012;62(5):891–901.PubMedGoogle Scholar
  12. Grande M, Tucci GF, Adorisio O, et al. Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc. 2002;16(2):313–6. Epub 2002/04/23. engPubMedGoogle Scholar
  13. Haber GP, Campbell SC, Colombo JR Jr, et al. Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches. Urology. 2007;70(5):910–5. Epub 2007/12/11. engPubMedGoogle Scholar
  14. Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207–12.PubMedGoogle Scholar
  15. Hayn MH, Hellenthal NJ, Hussain A, et al. Does previous robot-assisted radical prostatectomy experience affect outcomes at robot-assisted radical cystectomy? Results from the International Robotic Cystectomy Consortium. Urology. 2010a;76(5):1111–6.PubMedGoogle Scholar
  16. Hayn MH, Hussain A, Mansour AM, et al. The learning curve of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2010b;58(2):197–202.PubMedGoogle Scholar
  17. Herr HW. Neoadjuvant chemotherapy: a new treatment paradigm for muscle-invasive bladder cancer. Eur Urol. 2009;55(2):303–5.PubMedGoogle Scholar
  18. Hussein AA, Ahmed YE, Kozlowski JD, et al. Robot-assisted approach to ‘W’-configuration urinary diversion: a step-by-step technique. BJU Int. 2017;120(1):152–7.PubMedGoogle Scholar
  19. Jonsson MN, Adding LC, Hosseini A, et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder. Eur Urol. 2011;60(5):1066–73. Epub 2011/08/20. engPubMedGoogle Scholar
  20. Kang SG, Ko YH, Jang HA, et al. Initial experience of robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparison with extracorporeal method. J Laparoendosc Adv Surg Tech. 2012;22(5):456–62.Google Scholar
  21. Khan MS, Elhage O, Challacombe B, et al. Long-term outcomes of robot-assisted radical cystectomy for bladder cancer. Eur Urol. 2013;64(2):219–24.PubMedGoogle Scholar
  22. Knox ML, El-Galley R, Busby JE. Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach. J Endourol. 2013;27(1):40–4. Epub 2012/07/14. engPubMedGoogle Scholar
  23. Lee SW, Feingold DL, Carter JJ, et al. Peritoneal macrophage and blood monocyte functions after open and laparoscopic-assisted cecectomy in rats. Surg Endosc. 2003;17(12):1996–2002.PubMedGoogle Scholar
  24. Liedberg F. Early complications and morbidity of radical cystectomy. Eur Urol Suppl. 2010;9(1):25–30.Google Scholar
  25. Menon M, Hemal AK, Tewari A, et al. Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg. 2004;198(3):386–93. Epub 2004/03/03. engPubMedGoogle Scholar
  26. Mmeje CO, Martin AD, Nunez-Nateras R, Parker AS, Thiel DD, Castle EP. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy. Curr Urol Rep. 2013;14(1):26–31. Epub 2012/11/28. engPubMedGoogle Scholar
  27. Ost MC, Tan BJ, Lee BR. Urological laparoscopy: basic physiological considerations and immunological consequences. J Urol. 2005;174(4 Pt 1):1183–8. Epub 2005/09/08. engPubMedGoogle Scholar
  28. Pyun JH, Kim HK, Cho S, et al. Robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparative analysis with extracorporeal urinary diversion. J Laparoendosc Adv Surg Tech A. 2016;26(5):349–55.PubMedGoogle Scholar
  29. Raza SJ, Wilson T, Peabody JO, et al. Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2015;68(4):721–8.PubMedGoogle Scholar
  30. Richards KA, Kader AK, Otto R, Pettus JA, Smith JJ 3rd, Hemal AK. Is robot-assisted radical cystectomy justified in the elderly? A comparison of robotic versus open radical cystectomy for bladder cancer in elderly >/=75 years old. J Endourol. 2012;26(10):1301–6. Epub 2012/05/16. engPubMedGoogle Scholar
  31. Richards KA, Kader K, Pettus JA, Smith JJ, Hemal AK. Does initial learning curve compromise outcomes for robot-assisted radical cystectomy? A critical evaluation of the first 60 cases while establishing a robotics program. J Endourol. 2011;25(9):1553–8. Epub 2011/08/13. engPubMedGoogle Scholar
  32. Sammour T, Kahokehr A, Chan S, Booth RJ, Hill AG. The humoral response after laparoscopic versus open colorectal surgery: a meta-analysis. J Surg Res. 2010;164(1):28–37.PubMedGoogle Scholar
  33. Shariat SF, Karakiewicz PI, Palapattu GS, et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol. 2006;176(6):2414–22.PubMedGoogle Scholar
  34. Shim JS, Kwon TG, Rha KH, et al. Oncologic outcomes and predictive factors for recurrence following robot-assisted radical cystectomy for urothelial carcinoma: multicenter study from Korea. J Korean Med Sci. 2017;32(10):1662–8.PubMedPubMedCentralGoogle Scholar
  35. Simone G, Papalia R, Misuraca L, et al. Robotic intracorporeal padua ileal bladder: surgical technique, perioperative, oncologic and functional outcomes. Eur Urol. 2018;73(6):934–40.PubMedGoogle Scholar
  36. Smith AB, Raynor M, Amling CL, et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A. 2012;22(1):17–21. Epub 2011/12/07. engPubMedGoogle Scholar
  37. Studer UE, Turner WH. The ileal orthotopic bladder. Urology. 1995;45(2):185–9.PubMedGoogle Scholar
  38. Tan S, Yu W, Lin Z, et al. Peritoneal air exposure elicits an intestinal inflammation resulting in postoperative ileus. Mediat Inflamm. 2014;2014:924296. Epub 2014/08/21. engGoogle Scholar
  39. Xylinas E, Green DA, Otto B, et al. Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years. Urology. 2013;82(6):1323–9.PubMedGoogle Scholar
  40. Zehnder P, Gill IS. Cost-effectiveness of open versus laparoscopic versus robotic-assisted laparoscopic cystectomy and urinary diversion. Curr Opin Urol. 2011;21(5):415–9. Epub 2011/08/05. engPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of UrologyKorea University College of MedicineSeoulSouth Korea

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