Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: surgical technique, perioperative and early functional outcomes of a prospective single center series
In this prospective study (www.clinicaltrials.gov NCT02665156) we assessed the feasibility, safety and time efficiency of RARC with intracorporeal partly stapled “Padua Ileal Bladder” using robotic staplers.
Twenty-two consecutive patients with muscle invasive or high grade recurrent urothelial bladder carcinoma were treated between March 2016 and October 2016. Baseline, perioperative and follow-up data were prospectively collected. Key steps of surgery include: selection of 45 centimeters of ileum and division of the distal and proximal part of the ileum using robotic staplers; detubularization of the ileal loop; creation of the neo-bladder neck with one stapler load; double folding of the proximal ileal loop using two-three stapler loads; hand-sewing of the posterior neobladders wall with barbed suture; uretero-ileal anastomoses on JJ stents with a modified split-nipple technique; urethroneobladder anastomosis is performed according to Van Velthoven; hand-sewing of the anterior neobladders wall with barbed suture.
Median total operative time (“skin to skin”) was 270 minutes (IQR:255-295).
Median hospital stay was 9 days (IQR 8-11). Overall complication rate was 40.1% and overall severe complication incidence was 18.2%; at a median follow-up of 3 months, no patients developed recurrence, daytime continence rate was 59%.
We first report safety, feasibility and time efficiency in the use of robotic staplers to create orthotopic neobladder.