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Review
. 2019 Mar;26(3):334-340.
doi: 10.1111/iju.13900. Epub 2019 Jan 28.

Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer

Takuya Koie  1 , Chikara Ohyama  2 , Kazuhide Makiyama  3 , Toru Shimazui  4 , Tomoaki Miyagawa  5 , Kosuke Mizutani  1 , Tomohiro Tsuchiya  1 , Taku Kato  1 , Keita Nakane  1
Affiliations
Review

Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer

Takuya Koie et al. Int J Urol. 2019 Mar.

Abstract

Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder cancer. Robot-assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot-assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high-volume academic institutions. In the present review, we compare the totally intracorporeal robot-assisted radical cystectomy approach with open radical cystectomy and robot-assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle-invasive bladder cancer patients.

Keywords: intracorporeal urinary diversion; muscle-invasive bladder cancer; neoadjuvant chemotherapy; radical cystectomy; robot-assisted surgery.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Kaplan–Meier analysis of OS in patients with muscle‐invasive BCa who underwent RARC or MIE‐RC. The 5‐year OS rate was 80.8% in the RARC group and 84.6% in the MIE‐RC group (P = 0.647).
Figure 2
Figure 2
Selection of the appropriate portion of ileum that reaches the urethra without tension. A 40‐cm bowel segment is chosen for the neobladder. A 14‐Fr urethral catheter is inserted through the urethra to irrigate the ileum.
Figure 3
Figure 3
The ileal loop is fixed to the pelvic floor to facilitate ease of handling and the neobladder‐urethral anastomosis.
Figure 4
Figure 4
The detubularized ileal loop is arranged in an inverted U‐shape and the inner opposite borders are over‐sewn with a single‐layer seromuscular running suture.
Figure 5
Figure 5
After the ureteral anastomosis, the U‐flap is cross‐folded to make a pouch.
See this image and copyright information in PMC

Comment in

References

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