Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles.

BACKGROUND

The Vescica Ileale Padovana (VIP) was first described in 1989 as a technique for total bladder replacement, and gained popularity due to technical simplicity and functional advantages.

OBJECTIVE

To report preliminary results and a detailed step-by-step surgical technique description of robot-assisted VIP (ra-VIP) that replicates the open technique principles.

DESIGN, SETTING, AND PARTICIPANTS: We report the data of 15 consecutive patients who underwent robot-assisted radical cystectomy (RARC) and totally intracorporeal ra-VIP at our institution from April 2015 to March 2017.

SURGICAL PROCEDURE

RARC, extended pelvic lymph-node dissection, and totally intracorporeal ra-VIP. An enhanced recovery after surgery (ERAS) protocol was adopted in most cases.

MEASUREMENTS

Perioperative outcomes (operating time, blood loss, transfusion rate, and hospital stay), readmission for early (30d) and late (90d) postoperative complications, pathological and oncological outcomes, and overall/cancer-specific survival were reported.

RESULTS AND LIMITATIONS

The median (interquartile range) age was 60 (54-66)yr. The median body mass index was 24 (24-25). The median American Society of Anesthesiologists score was 2 (2-2). The operative time was 390 (284-470)min and the estimated blood loss was 300 (50-900) ml. No conversion to open technique was reported. The median hospital stay was 17 (12-23)d. Three patients received postoperative transfusions. Six patients had 90-d major complications. One patient was readmitted after discharge and reported a long-term sequela. One positive margin was reported. At a mean follow-up of 17 (13-25)mo, 14 (93%) patients were alive: one patient died from disease progression. Daytime continence rate at 12mo was 62%.

CONCLUSIONS

Our preliminary results showed that ra-VIP appears to be a feasible technique for robot-assisted totally intracorporeal bladder replacement following robotic radical cystectomy.

PATIENT SUMMARY

Vescica Ileale Padovana (VIP) was first described almost 30yr ago for bladder replacement after radical cystectomy. We report a step-by-step technique of robot-assisted VIP that follows the open surgical principles of detubularization and double folding, mixing the advantages of VIP with the benefits of the robotic approach.