Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
Department of Urology, Campus Biomedico University, Rome, Italy.
Eur Urol. 2018 Jun;73(6):934-940. doi: 10.1016/j.eururo.2016.10.018. Epub 2016 Oct 22.
Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility.
To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder.
DESIGN, SETTING, AND PARTICIPANTS: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre.
RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video.
Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported.
Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results.
Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience.
We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres.
机器人辅助根治性膀胱切除术（RARC）联合腔内新膀胱重建是一项具有挑战性的手术。由于对手术技能的要求较高且手术时间较长，人们对其可重复性表示担忧。
介绍我们行 RARC 及完全腔内原位 Padua 回肠膀胱的技术。
设计、地点和参与者：2012 年 8 月至 2014 年 2 月，在一家三级转诊中心，45 例患者接受了这种技术。
RARC、扩大盆腔淋巴结清扫术和腔内部分吻合新膀胱。手术步骤在随附的视频中演示。
收集患者的人口统计学、临床和病理数据。报告围手术期、2 年肿瘤学和 2 年功能结果。
术中无输血或转为开放手术，所有 45 例患者均成功完成腔内新膀胱。中位手术时间为 305min（四分位距 [IQR]：282-345）。中位估计失血量为 210ml（IQR：50-250）。中位住院时间为 9d（IQR：7-12）。围手术期、30d 和 180d 的总体并发症发生率分别为 44.4%、57.8%和 77.8%，严重并发症发生率分别为 17.8%、17.8%和 35.5%。2 年日间和夜间控尿率分别为 73.3%和 55.5%。2 年无病生存率、癌症特异性生存率和总生存率分别为 72.5%、82.3%和 82.4%。样本量小和中心高病例量可能会影响这些结果的可重复性。
我们的经验支持 RARC 后完全腔内新膀胱的可行性。随着经验的增加，手术时间和围手术期并发症的发生率可能会降低。
我们报告了首批 45 例连续接受机器人辅助根治性膀胱切除术联合腔内新膀胱的患者的结果。围手术期、肿瘤学和功能结果支持该技术作为三级转诊中心一种可行且安全的手术选择。
