ROBOT-ASSISTED TOTALLY INTRACORPOREAL PARTLY STAPLED VESCICA ILEALE PADOVANA (VIP)
INTRODUCTION AND OBJECTIVES: Robotic radical cystectomy (RC) with intracorporeal neobladder reconstruction is gaining popularity. Nevertheless it is still considered a challenging procedure characterized by a long operative time. Perioperative outcomes of robot assisted totally intracorporeal , orthotopic, Padua neobladder, using staplers to configure part of the neobladder are presented.
METHODS: From August 2012 to June 2014, 86 patients underwent robot-assisted RC with totally intracorporeal VIP. Staplers were used to configure part of the reservoir: neobladder neck and left aspect of the neobladder. Baseline demographics, pathology data, complications, and functional outcomes were assessed.
RESULTS: Robotic intracorporeal urinary diversion was successfully performed in 86 patients with a minimum 90-d follow-up. No intraoperative complications requiring transfusion or conversion to open surgery occurred. Median age and body mass index were 65 yr (61-70) and 27 kg/m2 (24,4-30), respectively. 31.5 % of the patients received neoadjuvant chemotherapy. Mean estimated blood loss was 210 ml (SD 60), median time to regular diet was 6 d (range: 5–21 d), median hospital stay was 9 d (range: 6–45 d). Minor complications (Clavien grade 1–2) occurred in 15 (27%) patients and major complicatios (grade 3–5) in 8 (9%) patients. Daytime and nighttime continence was 74.4% and 47.7%, respectively. No stones in the neobladder were observed
during the follow-up. This study is limited by small sample size and short follow-up period.
CONCLUSIONS: Robot-assisted orthotopic neobladder (VIP) is feasible and safe. The partially stapled neeobladder we presented could shorten operative time for totally intracorporeal urinary diversions.