Korean J Urol.  2008 Jun;49(6):506-509.

Robot-assisted Laparoscopic Radical Cystectomy with Ileal Conduit Urinary Diversion

• Park SY
• Cho KS
• Park KK
• Park SJ
• Ham WS
• Rha KH

Abstract

PURPOSE: In this study, we detail our initial experience with robot-assisted laparoscopic radical cystectomy(RLRC) with ileal conduit urinary diversion(ICUD) and describe the stepwise surgical procedure.
MATERIALS AND METHODS
Four men underwent RLRC with extracorporeal ICUD for muscle invasive bladder cancer. RLRC was performed by a single surgeon using the da Vinci(TM) robot system(Intuitive Surgical, Sunnyvale, USA) with four robot arms. The surgical specimen was extracted through the sub-umbilical incision, and ICUD was also achieved through the sub-umbilical incision by extracorporeal technique.
RESULTS
The mean operative time was 355+/-49.8 minutes, and the mean estimated blood loss was 550+/-57.7ml. The mean hospital stay was 12+/-2.9 days. There were no major complications. On surgical pathology, one patient had pTis, one patient had pT1, and two patients had pT3 transitional cell carcinoma of the bladder. There were no positive surgical margins or lymph nodes. The mean number of dissected lymph nodes was 17+/-4.6(range: 12-23).
CONCLUSIONS
Despite limited experience, RLRC is a feasible procedure with minimal blood loss, shorter hospital stay, and may be an alternative to the open technique.

Keyword

Robotics; Cystectomy; Urinary bladder neoplasms

MeSH Terms

Arm
Carcinoma, Transitional Cell
Cystectomy
Humans
Length of Stay
Lymph Nodes
Male
Muscles
Operative Time
Pathology, Surgical
Robotics
Urinary Bladder
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1. Port placement: 12mm robotic camera port (A); 8mm robotic arm ports for bipolar and monopolar instruments and grasper (B, C, D); 5mm assistant dominant port (E); 12mm assistant non-dominant hand port (F).

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  Fig. 2. Pelvic lymphadenectomy: The external iliac artery (A), external iliac vein (B), obturator nerve (C), and internal iliac artery (D) were skeletonized.

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  Fig. 3. Post-operative image of port sites and stoma.

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