Robot-assisted radical cystectomy with intracorporeal ileal neobladder – initial experience
I.Coman, N. Crisan, C.Manea, A. Boc, Cristina Ivan, Z. Mihaly
Clinical Department of Urology, Cluj-Napoca Municipal Hospital, Romania
Introduction and Objectives
Radical cystectomy is the standard treatment for infiltrating bladder cancer. The interest in minimally invasive techniques and robot-assisted radical cystectomy is growing in medical centers worldwide. In the video footage we are presenting the initial experience and the surgical technique used in robot-assisted radical cystectomy.
Material and Methods
Between January 2010 and November 2012, we performed 10 robotic radical cystectomies for infiltrating bladder tumour (9 men and 1 woman), out of which 3 patients had intracorporeal ileal neobladder. We assessed the perioperative parameters (operating time, blood loss, complications), oncological results (positive margins, number of lymph nodes) and functional results (continence, erection, kidney function) at 6 months postoperatively.
Results
The duration of surgical procedures for the 3 intracorporeal ileal neobladder procedures amounted to 725 minutes, 550 minutes and 490 minutes respectively, while blood loss added up to 450 ml, 600 ml and 350 ml respectively. There were no positive margins. We performed extended pelvic lymphadenectomy, along with the excision of 16, 19, and 23 lymph nodes, all of them being negative. Daytime and night-time continence was partially preserved, as patients used one pad / day and one pad / night. Nerve sparing technique was used for patients 2 and 3, as they presented erections under PDE 5 inhibitors. Postoperative imaging evaluation at 6 months showed normal appearance of the pyelocaliceal system without local or distant recurrence.
Conclusions. Robot-assisted radical cystectomy with with intracorporeal ileal neobladder is a feasible and safe technique for the treatment of infiltrating bladder cancer, with minimal morbidity and comparable oncological and functional results.