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Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center

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Abstract

The aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a modular training program at a referring center mentored by a worldwide-recognized robotic surgeon (P.W.). The program consisted of: (a) 10 h of theoretical lessons; (b) video session (c) step-by-step in vivo modular training. Each procedure was performed as taught, without any technique variation. Demographics, intra-operative data and post-operative complications, along with early functional outcomes, were recorded for each patient. We retrospectively evaluated the first consecutive 100 patients submitted to RARC with totally ICUD from July 2015 to December 2018. Median age at surgery was 69 years (IQR 60–74). 52 (52%), 32 (32%), and 17 (17%) patients received orthotopic neobladder, ileal conduit and uretero-cutaneostomy, respectively. Median operative time was 410 min. A median number of lymph nodes retrieved were 27 and median estimated blood loss was 240 mL with median hospitalization time of 7 days. All procedures were completed successfully without open conversion. A statistically significant improvement was found in the late (30–90 post-operative days) post-operative complications (p = 0.02) and operative time for urinary derivation. At multivariate logistic regression model ASA score ≥ 3 (OR = 4.2, p = 0.002) and number of lymph nodes retrieved (OR = 1.16, p = 0.02) were found to be predictors of 90-day complications. An adequate modular training is paramount to obtain successful results and reduce the learning curve of RARC, as demonstrated by our experience.

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Authors and Affiliations

  1. Department of Urology, Policlinico Di Abano, Abano Terme, Italy

    A. Porreca, F. Mineo Bianchi, D. Romagnoli, D. D’Agostino, P. Corsi, M. Giampaoli, A. Salvaggio & W. Artibani

  2. Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    F. Mineo Bianchi, L. Bianchi, R. Schiavina & E. Brunocilla

Authors
  1. A. Porreca
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  2. F. Mineo Bianchi
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  3. D. Romagnoli
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  4. D. D’Agostino
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  5. P. Corsi
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  6. M. Giampaoli
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  7. A. Salvaggio
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  8. L. Bianchi
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  9. R. Schiavina
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  10. E. Brunocilla
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  11. W. Artibani
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Corresponding author

Correspondence to F. Mineo Bianchi.

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Conflict of interest

Angelo Porreca, Federico Mineo Bianchi, Daniele Romagnoli, Daniele D’Agostino, Paolo Corsi, Marco Giampaoli, Antonio Salvaggio, Lorenzo Bianchi, Riccardo Schiavina, Eugenio Brunocilla, and Walter Artibani declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Informed consent was obtained from all patients for being included in the study.

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Porreca, A., Mineo Bianchi, F., Romagnoli, D. et al. Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center. J Robotic Surg 14, 261–269 (2020). https://doi.org/10.1007/s11701-019-00977-4

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  • DOI: https://doi.org/10.1007/s11701-019-00977-4

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