Journal List > Korean J Urol > v.49(6) > 1005124

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Park, Cho, Park, Park, Ham, and Rha: Robot-assisted Laparoscopic Radical Cystectomy with Ileal Conduit Urinary Diversion
Original Article

Korean J Urol 2008;49(6):506-509.

Published online: 21 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.6.506

Robot-assisted Laparoscopic Radical Cystectomy with Ileal Conduit Urinary Diversion

Sung Yul Park, Kang Su Cho, Kyung Kgi Park, Sung Jin Park, Won Sik Ham, Koon Ho Rha

Department of Urology, Urological Science Institute and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

Received 11 October 2007       Accepted 29 April 2008

Copyright © 2008 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In this study, we detail our initial experience with robot-assisted laparoscopic radical cystectomy (RLRC) with ileal conduit urinary diversion (ICUD) and describe the stepwise surgical procedure.

Materials and Methods

Four men underwent RLRC with extracorporeal ICUD for muscle invasive bladder cancer. RLRC was performed by a single surgeon using the da VinciTM robot system (Intuitive Surgical, Sunnyvale, USA) with four robot arms. The surgical specimen was extracted through the sub-umbilical incision, and ICUD was also achieved through the sub-umbilical incision by extracorporeal technique.

Results

The mean operative time was 355±49.8 minutes, and the mean estimated blood loss was 550±57.7ml. The mean hospital stay was 12±2.9 days. There were no major complications. On surgical pathology, one patient had pTis, one patient had pT1, and two patients had pT3 transitional cell carcinoma of the bladder. There were no positive surgical margins or lymph nodes. The mean number of dissected lymph nodes was 17±4.6 (range: 12-23).

Conclusions

Despite limited experience, RLRC is a feasible procedure with minimal blood loss, shorter hospital stay, and may be an alternative to the open technique.

Keywords: Robotics, Cystectomy, Urinary bladder neoplasms

REFERENCES

1. Hemal AK, Abol-Enein H, Tewari A, Shrivastava A, Shoma AM, Ghoneim MA, et al. Robotic radical cystectomy and urinary diversion in the management of bladder cancer. Urol Clin North Am. 2004; 31:719–29.
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Fig. 1.
Port placement: 12mm robotic camera port (A); 8mm robotic arm ports for bipolar and monopolar instruments and grasper (B, C, D); 5mm assistant dominant port (E); 12mm assistant non-dominant hand port (F).
kju-49-506f1.tif
Fig. 2.
Pelvic lymphadenectomy: The external iliac artery (A), external iliac vein (B), obturator nerve (C), and internal iliac artery (D) were skeletonized.
kju-49-506f2.tif
Fig. 3.
Post-operative image of port sites and stoma.
kju-49-506f3.tif
Table 1.
Clinical, perioperative, and pathologic data from 4 patients
Patients Age (years) BMI (kg/m2) Clinical stage OT (min) EBL (ml) Pathologic stage LN (n) Complication Hospital stay (day)
1 59 24.22 cT3N0M0 340 600 pT3N0M0 12 None 10
2 66 20.42 cT2N0M0 374 500 pT1N0M0 16 None 10
3 70 25.71 cT2N0M0 412 500 pTisN0M0 23 None 13
4 44 22.10 cT3N0M0 295 600 pT3N0M0 16 None 16

BMI: body mass index, EBL: estimated blood loss, LN: dissected lymph node, OT: total operation time

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