Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy.
Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy.
J Urol. 2017 Aug;198(2):436-444. doi: 10.1016/j.juro.2017.01.091. Epub 2017 Mar 21.
Robotic intracorporeal urinary diversion has mostly been done for ileal conduit or orthotopic neobladder diversion. We present what is to our knowledge the initial series, detailed technique and outcomes of the robotic intracorporeal Indiana pouch with a minimum 1-year followup.
Ten patients underwent robotic radical cystectomy, pelvic lymphadenectomy and intracorporeal Indiana pouch urinary diversion for cancer in 9 and benign disease in 1. Data were collected prospectively. Baseline demographics, pathology data, and 1-year complication rates and functional outcomes were assessed.
All 10 cases were successfully completed intracorporeally without open conversion. Median total operative time was 6 hours, including 3.5 hours for pouch creation. Median blood loss was 200 cc and median hospital stay was 10 days. Four Clavien grade 1-2 and 3 Clavien 3-5 complications occurred. None of the patients had a bowel leak. One noncompliant patient requested undiversion to an ileal conduit. The remaining 9 patients successfully catheterized the ileal channel and were completely continent at the last followup at a median of 13.7 months (range 12.3 to 15.2). Study limitations include small sample size and short followup.
We present what is to our knowledge the initial series of robotic completely intracorporeal Indiana pouch diversion. Early perioperative data indicate acceptable operative efficiency and complication rates. Longer followup is required to assess the functional outcomes of this less commonly performed diversion.
机器人辅助体内尿流改道术主要用于回肠导管或原位新膀胱尿流改道。我们介绍了机器人辅助体内印第安纳袋的初始系列，这是我们所知的首例，详细介绍了技术和结果，并且至少随访 1 年。
10 例患者因癌症（9 例）和良性疾病（1 例）接受了机器人根治性膀胱切除术、盆腔淋巴结清扫术和体内印第安纳袋尿流改道术。前瞻性地收集数据。评估了基线人口统计学、病理学数据以及 1 年并发症发生率和功能结果。
所有 10 例病例均成功完成了体内手术，无需开放转换。中位总手术时间为 6 小时，包括 3.5 小时的袋创建时间。中位出血量为 200cc，中位住院时间为 10 天。发生 4 例 Clavien 1-2 级和 3 例 Clavien 3-5 级并发症。没有患者发生肠漏。1 例不依从的患者要求将其改道至回肠导管。其余 9 例患者成功地经回肠通道导尿，并且在中位随访 13.7 个月（范围 12.3 至 15.2）时完全控尿。研究局限性包括样本量小和随访时间短。
我们介绍了机器人辅助完全体内印第安纳袋分流术的初始系列。早期围手术期数据表明，手术效率和并发症发生率可接受。需要更长时间的随访来评估这种较少实施的分流术的功能结果。
