Robot-assisted Radical Cystectomy (RARC) and Intracorporeal Orthotopic Neobladder

Robot-assisted radical cystectomy (RARC) and intracorporeal orthotopic neobladder (OINB) is technically a challenging surgery due to the involvement of prolonged console time and higher level of surgical skills.

We present the video demonstration on our technique of genital sparing RARC and OINB.

Materials and Methods:

28 year old patient presented with 5cm solid lesion in antero-lateral wall of bladder. TURBT was done, it was high grade urothelial carcinoma on HPE. She received 4 cycles of Neoadjuvant Chemotherapy. Robotic system was used. Genital sparing RARC done – both the ovaries and uterus were preserved. Modified Karolinska neobladder was done. A 55 cm of distal ileum was utilised. The first and most crucial step was performing the urethro-ileal anastomosis before bowel isolation (which helps identify the most dependent segment) using a 4-0 V-loc suture. Then ileum was isolated, and remaining bowel continuity was achieved with Endo-GIA staplers. Forty cm of distal ileum was detubularised, and ureteric anastomosis was done to proximal 15 cm of tubular ileum. The posterior plate suturing was done by using a 3-0 stratafix suture. The anterior wall was then folded to create a conical shape neobladder. Bricker's technique was used for Uretero-ileal anastomosis over ureteral stents, which were exteriorized, and suprapubic tube was kept

Results:

The console time was 384 min with blood loss of 200ml. She was discharged on 8th postoperative day. Perurethral catheter and SPC were removed at 3 and 4 weeks. She was continent from day of catheter removal. She is on self-intermittent catheterisation. We have completed 22 case of complete intra-corporeal neobladder. The patients' median age was 50.5 years. Median console time was 447.5 minutes (IQR, 347.5-500), blood loss was 225 ml (IQR, 200-250), and hospital stay was 12 days (IQR, 11-15). Most of the complications were Clavien-Dindo grade-I and II.

Conclusion:

Our experience supports RARC with OINB, with acceptable complications, good functional and survival outcomes, with better quality of life.