Korean J Urol.  2012 Nov;53(11):766-773.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

• Cho BC
• Jung HB
• Cho ST
• Kim KK
• Han JH
• Lee YS
• Lee YG

Abstract

PURPOSE
To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients.
MATERIALS AND METHODS
Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S).
RESULTS
The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1).
CONCLUSIONS
Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Keyword

Bladder cancer; Radical cystectomy; Robot-assisted surgery

MeSH Terms

Blood Transfusion
Body Mass Index
Cohort Studies
Constriction, Pathologic
Cystectomy
Follow-Up Studies
Humans
Ileus
Lymph Node Excision
Operative Time
Postoperative Complications
Skin
Urinary Bladder Neoplasms
Urinary Diversion
Vesicovaginal Fistula

Figure

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  FIG. 1 Ureters dissection. (A) The right ureter was identified as it crossed over the external iliac artery. (B) The left ureter was dissected with cold scissors after clamping Weck clips.

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  FIG. 2 Posterior dissection at the level of the Douglas pouch.

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  FIG. 3 (A) Suturing of the ureter in order to easily find it during neobladder formation. (B) Suturing of the urethra to facilitate the urethra-reservoir anastomosis.

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  FIG. 4 A modified Hautmann pouch was made with a double chimney extracorporeally.

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  FIG. 5 Anastomosis of the urethra-reservoir in the fashion of the intracorporeal method after redocking the robot system.

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  FIG. 6 Anastomosis of the urethra-reservoir in the fashion of the extracorporeal method by the open technique without redocking of the robot system.

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