Division of Urologic Surgery, The University of North Carolina, Chapel Hill, NC, USA.
J Endourol. 2012 Dec;26(12):1566-9. doi: 10.1089/end.2012.0447. Epub 2012 Oct 26.
Radical cystectomy is considered the standard of care for muscle-invasive bladder cancer. The use of minimally invasive techniques, particularly robot-assisted radical cystectomy, is steadily increasing with an acceptable learning curve, adequate lymph node yield, and acceptable perioperative complications. Longer-term follow-up is necessary to confirm oncologic efficacy, but early data are encouraging. While the majority of urinary diversions are performed extracorporeally, several recent small case studies have reported successful totally intracorporeal diversions, including both ileal conduit and orthotopic neobladder creation. Operative and short-term clinical outcomes have thus far been comparable to those of previously reported extracorporeal techniques. As surgeons gain experience with the robotic techniques needed for radical cystectomy, the frequency of intracorporeal urinary diversions will similarly increase. In this article, we describe the stepwise surgical procedure and perioperative management of the robot-assisted laparoscopic intracorporeal ileal conduit.
根治性膀胱切除术被认为是肌层浸润性膀胱癌的标准治疗方法。微创技术的应用，特别是机器人辅助根治性膀胱切除术，随着可接受的学习曲线、足够的淋巴结产量和可接受的围手术期并发症的出现，其应用稳步增加。需要进行更长时间的随访以确认肿瘤学疗效，但早期数据令人鼓舞。虽然大多数尿流改道是在体外进行的，但最近的几项小型病例研究报告了成功的完全体内尿流改道，包括回肠导管和原位新膀胱的创建。迄今为止，手术和短期临床结果与以前报道的体外技术相当。随着外科医生获得根治性膀胱切除术所需的机器人技术经验，体内尿流改道的频率也将相应增加。在本文中，我们描述了机器人辅助腹腔镜体内回肠导管的分步手术程序和围手术期管理。
