Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: perioperative and early functional outcomes of a single center prospective series
Robot assisted radical cystectomy (RARC) with totally intracorporeal orthotopic neobladders is a challenging surgical procedure. The potentially increased risk of neobladders stone formation consequent to the use of staplers to create the neobladders is still a matter of debate. Robotic staplers have been recently made commercially available. In this prospective study (www.clinicaltrials.gov NCT02665156) we assessed feasibility, safety and time efficiency of RARC with intracorporeal partly stapled “Padua Ileal Bladder” using robotic staplers.
Materials and Methods
Twenty-two consecutive patients with muscle-invasive or high grade recurrent urothelial carcinoma of the bladder were treated between March 2016 and October 2016. Perioperative outcomes were recorded and classified according to Clavien-Dindo classification system. The median follow-up was 3 months.
Six patients received neoadjuvant chemotherapy. All procedures were successfully completed; open conversion was never necessary. Median operative time was 270 minutes (IQR:255-295), median hospital stay was 9 days (IQR:8-11) and median EBL was 200 mL (IQR:150-300).
One patient (4,5%) had wound infection (CLavien grade 1), three patients (13.6%) had Clavien grade 2 complications (blood pack trasfusion, urinary tract infection requiring antibiotics, hypoxaemia requiring oxygen treatment), one patient (4.5%) needed urethral catheter replacement in the OR (Clavien grade 3b) and one patient (4.5%) had acute kidney failure requiring temporary dialysis (Clavien grade 4a). Post-operative readmission rate was 13.5% (one patient for candidaemia and two patients for ureteroileal strictures requiring nephrostomy tube insertion). Overall complication rate was 40.1% and overall severe complication incidence was 18.2%; 59.5% of patients did not experience any complication.
All patients had pure urothelial carcinoma. At final pathology 8 patients (36.4%) had undetectable disease (3 of which after neoadjuvant chemotherapy [ypT0]), and 6 patients (27.3%) had extravesical disease (pT3a-b). The median number of nodes removed was 25 (IQR:21-33). Three patients (13.6%) had pathologically involved nodes. CT scan performed 3 months postoperatively did not find any recurrence. At 3-mo evaluation day-time continence rate was 60%.
We first report safety and time efficiency in the use of robotic staplers to create totally intracorporeal orthotopic neobladder. Preliminary data highlight feasibility of this technique and favorable perioperative and functional outcomes. A longer follow-up and a larger cohort are necessary to assess oncologic efficacy of this procedure.
– Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes.
Simone G, Papalia R, Misuraca L, Tuderti G, Minisola F, Ferriero M, Vallati G, Guaglianone S, Gallucci M.
Eur Urol. 2016 Oct 22. pii: S0302-2838(16)30721-7. doi: 10.1016/j.eururo.2016.10.018. [Epub ahead of print]
– Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique.
Chopra S, de Castro Abreu AL, Berger AK, Sehgal S, Gill I, Aron M, Desai MM.
BJU Int. 2016 Jul 30. doi: 10.1111/bju.13611. [Epub ahead of print]