Robotic-assisted intracorporeal neobladder reconstruction with y-shaped reservoir: video description and clinical outcomes

You have accessJournal of UrologyCME1 Apr 2023V06-04 ROBOTIC-ASSISTED INTRACORPOREAL NEOBLADDER RECONSTRUCTION WITH Y-SHAPED RESERVOIR: VIDEO DESCRIPTION AND CLINICAL OUTCOMES Bernardo Rocco, Simone Assumma, Tommaso Calcagnile, Filippo Turri, Mattia Sangalli, Luca Sarchi, Giulia Garelli, Daniele Stroppa, Enrico Panio, Giorgio Bozzini, Salvatore Micali, Paolo Marcangeli, Angelica Grasso, Matteo Maggioni, Alberto Del Nero, Paolo Dell'Orto, and Maria Sighinolfi Bernardo RoccoBernardo Rocco More articles by this author , Simone AssummaSimone Assumma More articles by this author , Tommaso CalcagnileTommaso Calcagnile More articles by this author , Filippo TurriFilippo Turri More articles by this author , Mattia SangalliMattia Sangalli More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Giulia GarelliGiulia Garelli More articles by this author , Daniele StroppaDaniele Stroppa More articles by this author , Enrico PanioEnrico Panio More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Paolo MarcangeliPaolo Marcangeli More articles by this author , Angelica GrassoAngelica Grasso More articles by this author , Matteo MaggioniMatteo Maggioni More articles by this author , Alberto Del NeroAlberto Del Nero More articles by this author , Paolo Dell'OrtoPaolo Dell'Orto More articles by this author , and Maria SighinolfiMaria Sighinolfi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the hardest surgical challenges for robotic surgeon is intracorporeal neobladder reconstruction during robotic radical cystectomy (RARC). In the present video, we illustrate a step-by-step description of the technique and the clinical outcomes from a single center series. METHODS: Overall, 40 RARC were performed between July 2021 and October 2022: 20/40 patients underwent intracorporeal neobladder reconstruction and were enrolled in the study. When RARC is completed, a 40-50 cm ileal segment is isolated and the part with adequate mesenteric length is approximated to the urethral stump. A modified posterior reconstruction is conducted. Anastomosis with a barbed suture is finalized. Ileal segments at each side are isolated using robotic staplers and ileal-ileal anastomosis is accomplished. Ileum's reverse tubular U-segment is detubularized to create the neobladder. Posterior plane is first sutured; then, the orhotopic reservoir with two lateral limbs is created. After negative leakage test, a direct uretero-neobladder anastomosis of each spatulated ureter is performed in the dorsal part of the limbs. Ureteral stents are placed and brought out through the abdominal wall. Anterior plate is finally sutured. RESULTS: Mean age was 64.5 years (48-75). Seventeen out of 20 patients were males; 3 were females. One non-surgical intra-operative complication (myocardial infarction requiring an acceleration of operative time) was recorded. During post-op course, two cases of urinary leakage at the neovescical-urethral anastomosis were evident and required prolonged catheterization. Mean length of stay was 17 days (12-27), excluding a single case of prolonged hospitalization due to C. Albicans superinfection. The 30-day readmission rate was 20% (4/20) due to febrile urinary tract infections; 90-day readmission rate was just 5% (1 symptomatic lymphocele requiring percutaneous drainage). Most male patients (14/17) reported daytime continence with insignificant post-voided residual. Between those patients in which nerve-sparing approach was pursued – and have more than 90 days of follow up – 3/5 referred potency. Regarding female patients, incomplete voiding is reported in a case and urinary incontinence (2 pads/day) in another. CONCLUSIONS: Intracorporeal neobladder reconstruction is a complex procedure even for expert robotic surgeons. Nevertheless, the standardization of the surgical approach – as displayed in the video – facilitates a rapid implementation of the procedure with positive surgical and clinical outcomes. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e509 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Rocco More articles by this author Simone Assumma More articles by this author Tommaso Calcagnile More articles by this author Filippo Turri More articles by this author Mattia Sangalli More articles by this author Luca Sarchi More articles by this author Giulia Garelli More articles by this author Daniele Stroppa More articles by this author Enrico Panio More articles by this author Giorgio Bozzini More articles by this author Salvatore Micali More articles by this author Paolo Marcangeli More articles by this author Angelica Grasso More articles by this author Matteo Maggioni More articles by this author Alberto Del Nero More articles by this author Paolo Dell'Orto More articles by this author Maria Sighinolfi More articles by this author Expand All Advertisement PDF downloadLoading ...