Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Eur Urol. 2013 Apr;63(4):637-43. doi: 10.1016/j.eururo.2012.11.055. Epub 2012 Dec 8.
Robot-assisted radical cystectomy (RARC) has evolved over the last few years to become an acceptable alternative option to open radical cystectomy. Most series of RARC used an open approach to urinary diversion. Even though robot-assisted intracorporeal urinary diversion (RICUD) is the natural extension of RARC, few centers have reported their experiences with RICUD in general, and in particular, of robot-assisted intracorporeal ileal conduits (RICIC).
To report our experience with RICIC using the Marionette technique.
DESIGN, SETTING, AND PARTICIPANTS: The first 100 consecutive patients who underwent RARC and RICIC, and had ≥ 3 mo of postoperative follow-up were included in this study. Patients were divided into four groups of 25 patients each to study the evolution of our surgical technique.
RICIC.
Intraoperative, pathologic, and 90-d postoperative outcomes for the four groups and the overall cohort were compared using the Fisher exact test (categorical variables) and the Kruskal-Wallis test (continuous variables). Continuous variables were reported as median (range) and categorical variables were specified as frequency (percentage).
Overall operative and specific diversion times were 352 and 123 min, respectively. Estimated blood loss was 300 ml, lymph node yield was 24, and positive surgical margin rate was 4%. Length of hospital stay increased from 7 d for group 1 to 9 d for group 4. The overall 90-d complication rate was 81%; 19% of complications were high grade. Infections were the most common complications, representing 31% of all complications. There were no statistically significant intergroup differences except in diversion time, intraoperative transfusions, and length of stay.
RICIC diversion is safe, feasible, and reproducible. Larger series with longer follow-up are needed to validate the procedure and define its place in the minimally invasive urologic armamentarium. Quality of life studies need to be conducted to compare benefits of intracorporeal urinary diversion.
机器人辅助根治性膀胱切除术（RARC）在过去几年中已经发展成为开放式根治性膀胱切除术的可接受替代方案。大多数 RARC 系列手术都采用开放式尿流改道术。尽管机器人辅助腔内尿流改道术（RICUD）是 RARC 的自然延伸，但很少有中心报告其一般 RICUD 经验，特别是机器人辅助腔内回肠导管术（RICIC）。
报告我们使用 Marionette 技术进行 RICIC 的经验。
设计、地点和参与者：这项研究纳入了前 100 例连续接受 RARC 和 RICIC 且术后随访时间≥3 个月的患者。将患者分为 4 组，每组 25 例，以研究我们手术技术的演变。
RICIC。
使用 Fisher 确切检验（分类变量）和 Kruskal-Wallis 检验（连续变量）比较了四组和整个队列的术中、病理和 90 天术后结果。连续变量以中位数（范围）表示，分类变量以频率（百分比）表示。
总体手术和特定分流时间分别为 352 分钟和 123 分钟。估计失血量为 300ml，淋巴结产量为 24 个，阳性切缘率为 4%。住院时间从第 1 组的 7 天增加到第 4 组的 9 天。整体 90 天并发症发生率为 81%；19%的并发症为高级别。除分流时间、术中输血和住院时间外，各组间无统计学差异。
RICIC 分流术安全、可行且可重复。需要更大的系列和更长的随访时间来验证该程序，并确定其在微创泌尿外科武器库中的位置。需要进行生活质量研究，以比较腔内尿流改道的益处。
