Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles.
Intracorporeal urinary diversion
Paduan ileal pouch
Robot-assisted radical cystectomy
Robotic urinary diversion
Vescica Ileale Padovana
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
12
09
2018
accepted:
16
11
2018
pubmed:
5
12
2018
medline:
24
7
2020
entrez:
5
12
2018
Statut:
ppublish
Résumé
The Vescica Ileale Padovana (VIP) was first described in 1989 as a technique for total bladder replacement, and gained popularity due to technical simplicity and functional advantages. To report preliminary results and a detailed step-by-step surgical technique description of robot-assisted VIP (ra-VIP) that replicates the open technique principles. We report the data of 15 consecutive patients who underwent robot-assisted radical cystectomy (RARC) and totally intracorporeal ra-VIP at our institution from April 2015 to March 2017. RARC, extended pelvic lymph-node dissection, and totally intracorporeal ra-VIP. An enhanced recovery after surgery (ERAS) protocol was adopted in most cases. Perioperative outcomes (operating time, blood loss, transfusion rate, and hospital stay), readmission for early (30d) and late (90d) postoperative complications, pathological and oncological outcomes, and overall/cancer-specific survival were reported. The median (interquartile range) age was 60 (54-66)yr. The median body mass index was 24 (24-25). The median American Society of Anesthesiologists score was 2 (2-2). The operative time was 390 (284-470)min and the estimated blood loss was 300 (50-900) ml. No conversion to open technique was reported. The median hospital stay was 17 (12-23)d. Three patients received postoperative transfusions. Six patients had 90-d major complications. One patient was readmitted after discharge and reported a long-term sequela. One positive margin was reported. At a mean follow-up of 17 (13-25)mo, 14 (93%) patients were alive: one patient died from disease progression. Daytime continence rate at 12mo was 62%. Our preliminary results showed that ra-VIP appears to be a feasible technique for robot-assisted totally intracorporeal bladder replacement following robotic radical cystectomy. Vescica Ileale Padovana (VIP) was first described almost 30yr ago for bladder replacement after radical cystectomy. We report a step-by-step technique of robot-assisted VIP that follows the open surgical principles of detubularization and double folding, mixing the advantages of VIP with the benefits of the robotic approach.
Sections du résumé
BACKGROUND
The Vescica Ileale Padovana (VIP) was first described in 1989 as a technique for total bladder replacement, and gained popularity due to technical simplicity and functional advantages.
OBJECTIVE
To report preliminary results and a detailed step-by-step surgical technique description of robot-assisted VIP (ra-VIP) that replicates the open technique principles.
DESIGN, SETTING, AND PARTICIPANTS
We report the data of 15 consecutive patients who underwent robot-assisted radical cystectomy (RARC) and totally intracorporeal ra-VIP at our institution from April 2015 to March 2017.
SURGICAL PROCEDURE
RARC, extended pelvic lymph-node dissection, and totally intracorporeal ra-VIP. An enhanced recovery after surgery (ERAS) protocol was adopted in most cases.
MEASUREMENTS
Perioperative outcomes (operating time, blood loss, transfusion rate, and hospital stay), readmission for early (30d) and late (90d) postoperative complications, pathological and oncological outcomes, and overall/cancer-specific survival were reported.
RESULTS AND LIMITATIONS
The median (interquartile range) age was 60 (54-66)yr. The median body mass index was 24 (24-25). The median American Society of Anesthesiologists score was 2 (2-2). The operative time was 390 (284-470)min and the estimated blood loss was 300 (50-900) ml. No conversion to open technique was reported. The median hospital stay was 17 (12-23)d. Three patients received postoperative transfusions. Six patients had 90-d major complications. One patient was readmitted after discharge and reported a long-term sequela. One positive margin was reported. At a mean follow-up of 17 (13-25)mo, 14 (93%) patients were alive: one patient died from disease progression. Daytime continence rate at 12mo was 62%.
CONCLUSIONS
Our preliminary results showed that ra-VIP appears to be a feasible technique for robot-assisted totally intracorporeal bladder replacement following robotic radical cystectomy.
PATIENT SUMMARY
Vescica Ileale Padovana (VIP) was first described almost 30yr ago for bladder replacement after radical cystectomy. We report a step-by-step technique of robot-assisted VIP that follows the open surgical principles of detubularization and double folding, mixing the advantages of VIP with the benefits of the robotic approach.
Identifiants
pubmed: 30509764
pii: S0302-2838(18)30936-9
doi: 10.1016/j.eururo.2018.11.037
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
381-390Informations de copyright
Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.