Iwata Takehiro, Kobayashi Yasuyuki, Maruyama Yuki, Kawada Tatsushi, Sadahira Takuya, Oiwa Yuko, Katayama Satoshi, Nishimura Shingo, Takamoto Atsushi, Sako Tomoko, Wada Koichiro, Edamura Kohei, Araki Motoo, Watanabe Masami, Watanabe Toyohiko, Nasu Yasutomo
Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama-City, Okayama, 700-8558, Japan.
Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Int J Clin Oncol. 2021 Sep;26(9):1714-1721. doi: 10.1007/s10147-021-01957-1. Epub 2021 Jun 4.
The aim of this study is to compare the perioperative outcomes and learning curves between intracorporeal and extracorporeal urinary diversion at our medium-sized institution.
Between January 2018 and September 2020, a single surgeon at our institution performed 46 consecutive robot-assisted radical cystectomies with ileal conduit. We compared the perioperative outcomes between patients who underwent intracorporeal versus extracorporeal urinary diversion. We also investigated learning curves for the first and last 10 patients in each group.
The extracorporeal group had shorter overall operative time (P = 0.003) and urinary diversion time (P < 0.0001) than the intracorporeal group. The intracorporeal group had shorter length of hospital stay (P = 0.02). There was no difference in complication and readmission rates. The extracorporeal group demonstrated no difference between the first and last 10 patients for overall operative time or time for cystectomy, lymph node dissection, or urinary diversion. However, the intracorporeal group had shorter urinary diversion time for the last 10 patients compared with the first 10 patients. The first 10 patients in the extracorporeal group had shorter overall operative time than the first 10 in the intracorporeal group, but there was no difference for the last 10 patients.
Intracorporeal urinary diversion requires longer overall operative time than extracorporeal diversion for the first 10 patients, due to longer urinary diversion time. However, there is no difference in overall operative time for the last 10 patients. The benefit of intracorporeal over extracorporeal urinary diversion was not confirmed at our medium-sized institution.
本研究旨在比较在我们这家中型机构中，体内与体外尿液改道的围手术期结局及学习曲线。
在2018年1月至2020年9月期间，我们机构的一名外科医生连续进行了46例机器人辅助根治性膀胱切除术并采用回肠导管术。我们比较了接受体内与体外尿液改道患者的围手术期结局。我们还研究了每组中最初10例和最后10例患者的学习曲线。
体外组的总手术时间（P = 0.003）和尿液改道时间（P < 0.0001）比体内组短。体内组的住院时间较短（P = 0.02）。并发症和再入院率无差异。体外组最初10例和最后10例患者在总手术时间或膀胱切除术、淋巴结清扫术或尿液改道时间方面无差异。然而，体内组最后10例患者的尿液改道时间比最初10例患者短。体外组的最初10例患者总手术时间比体内组的最初10例短，但最后10例患者之间无差异。
由于尿液改道时间较长，对于最初10例患者，体内尿液改道比体外尿液改道需要更长的总手术时间。然而，最后10例患者的总手术时间无差异。在我们这家中型机构中，未证实体内尿液改道优于体外尿液改道。
