Early experience with robot-assisted radical cystectomy and intracorporeal ileal conduit urinary diversion at Fujita Health University School of Medicine

Objectives: Open radical cystectomy (ORC) is a highly invasive, but widely performed, standard treatment for muscle-invasive bladder cancer (MIBC). Robot-assisted radical cystectomy (RARC) is increasingly performed worldwide as a minimally invasive procedure that can replace ORC. In June 2011, we started performing RARC procedures in which urinary diversion is performed intracorporeally. We compared the safety and invasiveness of RARC and ORC procedures that were performed in the same period. Methods: Sixteen patients who underwent RARC and intracorporeal ileal conduit urinary diversion (IC-ICUD) were included. Robot-assisted surgery was performed with a head-down tilt of 30° and radical cystectomy was performed transperitoneally. The head-down tilt was then adjusted to 10°–15° for performing IC-ICUD. Results: All RARC+IC-ICUD procedures were completed without conversion to ORC. The median operation time was 373 min (276–497 min), median console time was 320 min (227–431 min), and median estimated blood loss volume was 200 ml (100–1500 ml). No ≥grade 3 complications as per the Clavien–Dindo classification were identified. RARC had lower blood loss and transfusion rates compared with ORC, thereby shortening the postoperative hospital stay. Conclusions: We reported our experiences with RARC+IC-ICUD and describe the operative method. IC-ICUD accelerates postoperative recovery of intestinal function and decreases the rate of complications, such as intestinal obstruction and ureteral stenosis. Our findings suggest that RARC+IC-ICUD can be performed with minimal invasiveness and high safety in patients with MIBC.