Yajima Shugo, Nakanishi Yasukazu, Umino Yousuke, Ookubo Naoya, Tanabe Kenji, Kataoka Madoka, Masuda Hitoshi
National Cancer Center Hospital East, Chiba, Japan.
Turk J Urol. 2022 Nov;48(6):415-422. doi: 10.5152/tud.2022.22125.
This study was designed to describe our hybrid approach to intracorporeal urinary diversion and evaluate surgical experience during initial induction.
Clinical data from 38 patients with bladder cancer undergoing robot-assisted radical cystectomy with ileal conduit hybrid approach to intracorporeal urinary diversion at our institution between May 2020 and January 2022 were reviewed. The hybrid approach to intracorporeal urinary diversion pro cedure involved the following: radical cystectomy, removing a specimen through a 4- to 6-cm skin incision, harvesting an ileal conduit, redocking the robot, and uretero-uretero anastomosis. The relationship between surgical experience and operative time and a Clavien-Dindo classification of grade >3 was evaluated.
Of the 38 patients, 30 (79%) were male, and the median age was 75 years (interquartile range, 71-80 years). The total operative time was 384 minutes (interquartile range, 348-409 minutes). The estimated blood loss was 244 mL (interquartile range, 124-445 mL). No bowel injuries or conversions to laparoscopy or laparotomy were encountered. High-grade postoperative complications (Clavien-Dindo classification grade > 3) occurred in 7 cases (19%). The overall 90-day readmission rate following discharge after surgery was 5%. The relationship between surgical experience and operative time was nonlinear. A plateau was not reached in all 38 patients.
Our hybrid approach to intracorporeal urinary diversion technique can be accomplished safely with acceptable operative times, even with little surgical experience. This procedure might be a safe treat ment option that is relatively easy to perform, particularly in an institution that has not yet introduced intra corporeal urinary diversion. Future randomized trials with larger samples and longer follow-up periods are required to confirm our findings.
本研究旨在描述我们的体内尿流改道混合方法，并评估初始引入阶段的手术经验。
回顾了2020年5月至2022年1月期间在我院接受机器人辅助根治性膀胱切除术并采用回肠导管混合方法进行体内尿流改道的38例膀胱癌患者的临床资料。体内尿流改道手术的混合方法包括：根治性膀胱切除术，通过4至6厘米的皮肤切口取出标本，采集回肠导管，重新对接机器人，以及输尿管-输尿管吻合术。评估手术经验与手术时间以及Clavien-Dindo分级>3之间的关系。
38例患者中，30例（79%）为男性，中位年龄为75岁（四分位间距，71 - 80岁）。总手术时间为384分钟（四分位间距，348 - 409分钟）。估计失血量为244毫升（四分位间距，124 - 445毫升）。未发生肠损伤，也未转为腹腔镜手术或开腹手术。7例（19%）发生了高级别术后并发症（Clavien-Dindo分级>3）。术后出院后90天的总体再入院率为5%。手术经验与手术时间之间的关系是非线性的。38例患者均未达到平台期。
我们的体内尿流改道混合技术即使在手术经验较少的情况下也能在可接受的手术时间内安全完成。该手术可能是一种相对容易实施的安全治疗选择，特别是在尚未引入体内尿流改道的机构中。需要未来进行更大样本量和更长随访期的随机试验来证实我们的发现。
