Dason Shawn, Goh Alvin C
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
Curr Urol Rep. 2018 Mar 15;19(5):28. doi: 10.1007/s11934-018-0778-z.
More than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery.
In this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles. Several potential benefits of intracorporeal urinary diversion are being investigated-such as a reduction in gastrointestinal complications, ureteral strictures, and wound complications. Finally, we highlight the important aspects of establishing an intracorporeal urinary diversion program integrated with an Enhanced Recovery after Surgery (ERAS) program. We have included the perioperative outcomes of 100 consecutive cases of intracorporeal urinary diversion with an Enhanced Recovery after Surgery (ERAS) protocol. In this series, 49% were continent diversions. Patients had a median length of stay of 5 days, with 37% staying 4 days or less. High-grade complications and readmissions were noted in 22 and 20% of patients, respectively. The benefits of intracorporeal urinary diversion appear promising, and there is continued need for high-quality randomized controlled trials to define its role in patients undergoing radical cystectomy.
经过一个多世纪的发展，现代尿流改道术应运而生。机器人体内尿流改道术必须遵循开放手术所定义的原则，这一点至关重要。
在本综述中，我们讨论了促成现代尿流改道技术的基本开放手术原则。然后，我们在这些手术原则的背景下概述了几种最近描述的机器人体内尿流改道术的技术方面。体内尿流改道的一些潜在益处正在研究中，例如减少胃肠道并发症、输尿管狭窄和伤口并发症。最后，我们强调了建立与术后加速康复（ERAS）计划相结合的体内尿流改道计划的重要方面。我们纳入了100例连续采用术后加速康复（ERAS）方案的体内尿流改道患者的围手术期结果。在这个系列中，49%为可控性尿流改道。患者的中位住院时间为5天，37%的患者住院4天或更短。分别有22%和20%的患者出现高级别并发症和再次入院情况。体内尿流改道的益处似乎很有前景，仍需要高质量的随机对照试验来确定其在接受根治性膀胱切除术患者中的作用。
