Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Eur Urol. 2010 Jun;57(6):1013-21. doi: 10.1016/j.eururo.2009.12.028. Epub 2010 Jan 9.
Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy (RALRC). In most of these series, the urinary diversion has been performed in an extracorporeal fashion. There have been few case reports of an intracorporeal diversion and little description of the technique of such a procedure.
In this paper, we report our initial experience with robotic-assisted laparoscopic intracorporeal urinary diversion, describing stepwise the surgical procedure itself and evaluating perioperative and pathologic outcomes of this novel procedure.
DESIGN, SETTING, AND PARTICIPANTS: We studied a single-institution case series of patients undergoing robotic-assisted cystectomy and intracorporeal urinary diversion for clinically localized urothelial carcinoma of the bladder (n=10) or for a noncompliant dysfunctional bladder refractory to more conservative management (n=2). Historical comparisons are also made to a consecutive case series of 20 patients undergoing robotic radical cystectomy and extracorporeal urinary diversion.
RALRC and intracorporeal urinary diversion, including ileal conduit (n=9) and orthotopic ileal neobladder (n=3).
The stepwise operative procedure is described in detail. Outcome measures evaluated in this series included operative variables, hospital recovery, and complication rate. Comparisons were made to a contemporaneous series of 20 patients who underwent a robotic cystectomy with extracorporeal diversion during this time period (from an experience of >100 robotic cystectomy patients since 2005).
Twelve patients (mean age: 60.9 yr) underwent an intracorporeal diversion. Mean operating-room time of all patients was 5.3h, and mean surgical blood loss was 221ml. Mean time to flatus, bowel movement, and hospital discharge was 2.2 d, 3.2 d, and 4.5 d, respectively. Eleven of the 12 patients were discharged on or before postoperative day 5. There were six postoperative complications in five patients (42%), with one complication being Clavien grade 3 or higher. The major limitations of the study are the small sample size and the nonrandomized nature of the compared treatment groups (intracorporeal vs extracorporeal), which limits the ability to directly compare the techniques at a high level of scientific confidence.
Our initial experience with robotic-assisted laparoscopic intracorporeal diversion appears to be favorable with acceptable operative and short-term clinical outcomes.
目前已经有一些关于机器人辅助腹腔镜根治性膀胱切除术（RALRC）的小病例系列报告。在这些系列中，大多数尿流改道都是在体外进行的。仅有少数关于腔内分流术的病例报告，对这种手术技术的描述也很少。
本文报告了我们在机器人辅助腹腔镜腔内尿流改道方面的初步经验，详细描述了手术过程，并评估了这一新方法的围手术期和病理结果。
设计、地点和参与者：我们研究了单中心病例系列，包括 10 例临床局限性膀胱尿路上皮癌和 2 例非依从性功能失调性膀胱对更保守治疗无效的患者，他们接受了机器人辅助膀胱切除术和腔内尿流改道。也与同期接受机器人根治性膀胱切除术和体外尿流改道的 20 例患者的连续病例系列进行了历史比较。
RALRC 和腔内尿流改道，包括回肠导管（n=9）和原位回肠新膀胱（n=3）。
详细描述了逐步手术过程。本系列评估的结果测量包括手术变量、住院恢复和并发症发生率。与同期接受机器人膀胱切除术和体外分流术的 20 例患者进行了比较（自 2005 年以来，我们有超过 100 例机器人膀胱切除术的经验）。
12 例患者（平均年龄：60.9 岁）接受了腔内分流术。所有患者的平均手术室时间为 5.3 小时，平均手术出血量为 221ml。平均排气、排便和出院时间分别为 2.2 天、3.2 天和 4.5 天。12 例患者中有 11 例在术后第 5 天或之前出院。5 例患者发生 6 例术后并发症（42%），其中 1 例并发症为 Clavien 3 级或更高级别。该研究的主要局限性是样本量小，以及腔内与体外治疗组之间的非随机设计（腔内与体外），这限制了以高科学置信度直接比较技术的能力。
我们在机器人辅助腹腔镜腔内分流术方面的初步经验似乎是有利的，具有可接受的手术和短期临床结果。
