Medina Luis G, Baccaglini Willy, Hernández Angélica, Rajarubendra Nieroshan, Winter Matthew, Ashrafi Akbar N, Tafuri Alessandro, Cacciamani Giovanni E, Sotelo Rene
Catherine & Joseph Aresty Department of Urology. USC Institute of Urology and the Keck School of Medicine. University of Southern California. Los Angeles. CA. USA.
Arch Esp Urol. 2019 Apr;72(3):299-308.
To present a review of the technical aspects of robotic intracorporeal ileal conduit (IC) reconstruction after robot assisted radical cystectomy (RARC). METHODS: A non-systematic review is performed in order to summarize technical aspects on robot assisted ileal conduit procedure following radical cystectomy in patients with muscle invasive bladder cancer. RESULTS: Radical cystectomy with pelvic lymph node dissection and urinary diversion is the gold-standard therapy for localized muscle-invasive bladder cancer. IC is the most common diversion utilized by surgeons. Minimally invasive approaches to IC were proposed with the intention of decreasing the morbidity associated to open surgery. Several oncological, and functional factors should be taken into consideration for the selection of patients undergoing this procedure together with surgeons and patients' preferences. The stoma marking of the patient is of critical importance. Identification of the ureters should be done assuring careful handling of the tissue and then isolation of the bowel segments should be performed after confirming proper length of the segment. Side to side anastomosis of the antimesenteric borders of the bowel is performed with linear staplers, and the ureteroileal anastomosis is done. Finally, the ileal conduit is positioned close to the stoma marking site and is fixed to the skin. Urinary diversion and radical cystectomy is a very morbid procedure. Mainly, complications are gastrointestinal, stoma-related, or associated to the ureter-enteric anastomosis. CONCLUSIONS: The advantages of the robotic platform concerning postoperative outcomes may be more evident if the procedure is done in an intracorporeal fashion. Proper knowledge and mastery of the technical aspects of this procedure are critical.
对机器人辅助根治性膀胱切除术后机器人体内回肠代膀胱术（IC）重建的技术方面进行综述。方法：进行非系统性综述，以总结肌肉浸润性膀胱癌患者根治性膀胱切除术后机器人辅助回肠代膀胱术的技术方面。结果：根治性膀胱切除术加盆腔淋巴结清扫和尿流改道是局限性肌肉浸润性膀胱癌的金标准治疗方法。IC是外科医生最常用的尿流改道术式。为降低开放手术相关的发病率，人们提出了微创IC手术方法。在选择接受该手术的患者时，应考虑几个肿瘤学和功能因素，同时还要考虑外科医生和患者的偏好。患者的造口标记至关重要。应确保仔细处理组织来识别输尿管，然后在确认肠段长度合适后进行肠段分离。用直线缝合器进行肠管系膜对侧缘的侧侧吻合，然后进行输尿管-回肠吻合。最后，将回肠代膀胱放置在靠近造口标记的位置并固定到皮肤上。尿流改道和根治性膀胱切除术是一种创伤性很大的手术。主要并发症是胃肠道、造口相关或与输尿管-肠吻合相关的并发症。结论：如果以体内方式进行手术，机器人平台在术后结果方面的优势可能会更明显。正确掌握该手术的技术方面至关重要。
