938 ROBOTIC-ASSISTED LAPAROSCOPIC INTRACORPOREAL URINARY DIVERSION

摘要

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010938 ROBOTIC-ASSISTED LAPAROSCOPIC INTRACORPOREAL URINARY DIVERSION Stephen McKim, Eugene Simopoulos, Angela Smith, Matthew Raynor, Matthew Nielsen, Eric Wallen, and Raj Pruthi Stephen McKimStephen McKim More articles by this author , Eugene SimopoulosEugene Simopoulos More articles by this author , Angela SmithAngela Smith More articles by this author , Matthew RaynorMatthew Raynor More articles by this author , Matthew NielsenMatthew Nielsen More articles by this author , Eric WallenEric Wallen More articles by this author , and Raj PruthiRaj Pruthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. In most of these series, the urinary diversion has been performed in an extracorporeal fashion. This has been few case reports of an intracorporeal diversion, and little description of the technique of such a procedure. Herein, we report our initial experience with robotic-assisted laparoscopic intracorporeal urinary diversion describing stepwise the surgical procedure itself, and evaluating peri-operative and pathologic outcomes of this novel procedure. METHODS Twelve patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal urinary diversion. Outcome measures evaluated in this series included operative variables, hospital recovery, and complication rate. Comparisons were made to the most recent 20 consecutive patients who underwent a robotic cystectomy with extracorporeal diversion from an experience of over 100 robotic cystectomy patients since 2005. RESULTS Mean age was 60.9 years (range 45-70 years). Nine patients underwent intracorporeal ileal conduit diversion and 3 underwent an orthotopic neobladder. Mean OR time of all patients was 5.3 hours (4.3 – 7.3 hrs) with a mean time of intracorporeal diversion of 3.0 hours. There were 6 complications in 5 patients (1 patient Clavien 3 or higher) – only one apparently related to the urinary diversion (mis-placed ureteral stent). Outcomes and comparisons to the extracorporeal diversion cohort are shown in the table. OR Time Time to BM Time to DC % Comps Intracorporeal (N=12) 5.3h 3.2d 4.5d 42% Extracorporeal (N=20) 4.2h* 3.3d 5.2d 35% CONCLUSIONS Our initial experience with robotic-assisted laparoscopic intracorporeal diversion appears to be favorable with acceptable operative, and short-term clinical outcomes. As our experience increases, we should expect to continue to refine our surgical technique and reduce operating room times. Certainly, larger experiences are required to adequately evaluate and validate this procedure as an appropriate surgical option for the bladder cancer patient or other patient requiring urinary diversion. Chapel Hill, NC© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e365-e366 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Stephen McKim More articles by this author Eugene Simopoulos More articles by this author Angela Smith More articles by this author Matthew Raynor More articles by this author Matthew Nielsen More articles by this author Eric Wallen More articles by this author Raj Pruthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...