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Simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy: technique description, outcomes, and literature summary

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Abstract

The objectives of this study are to describe the surgical technique for simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy, to report its surgical bench marks, and finally, to summarize the current evidence on the procedure. After written informed consent, we prospectively enrolled consecutive patients undergoing simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy in a prospective institutional database. We performed all procedures with robotic assistance from the DaVinci Si-HD®, a four-arm robotic system. Endpoints included surgery duration, estimated intra-operative blood loss, resection margins, intra-, and post-operative complications. Furthermore, we describe oncological outcome at follow-up. We conducted six (54.4 %) right-sided and five (45.5 %) left-sided nephro-ureterectomies. Urinary diversion consisted in nine (81.2 %) ureterocutaneostomies and in two (18.8 %) ileum conduits. The median surgery duration was 287 min [interquartile range (Q1–Q3) 253–328], thereof 196-min console time (Q1–Q3 158–230). The median-estimated blood loss was 235 mL (Q1–Q3 200–262). We did not register any intra-operative complications or conversions to open surgery. Post-operatively, each one patient suffered a Clavien-Dindo grade 1 (paralytic ileus), grade 2 (blood transfusion), and grade 3 complication (port hernia). After a median follow-up of 7 months (Q1–Q3 4–25), we registered one recurrence, a metachronous transitional cell cancer of the contralateral kidney 24 months after the initial procedure. En-bloc robot-assisted radical cystectomy and nephro-ureterectomy was associated with limited procedure duration, minor blood loss and satisfying intra- and post-operative outcomes.

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Authors and Affiliations

  1. Department of Urology, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Germany

    Stephan Buse, Carolin Eva Hach & Assen Alexandrov

  2. Department of Urology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany

    Stephan Buse, Rene Mager & Axel Haferkamp

Authors
  1. Stephan Buse
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  2. Carolin Eva Hach
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  3. Assen Alexandrov
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  4. Rene Mager
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  5. Axel Haferkamp
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Corresponding author

Correspondence to Stephan Buse.

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Conflict of interest

Stephan Buse acts as proctor for the DaVinci Si-HD® System, Intuitive Surgical Inc., Sunnyvale, US. C.E. Hach, A. Alexandrov: R Mager, A. Haferkamp none

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Buse, S., Hach, C.E., Alexandrov, A. et al. Simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy: technique description, outcomes, and literature summary. J Robotic Surg 10, 315–322 (2016). https://doi.org/10.1007/s11701-016-0600-1

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  • DOI: https://doi.org/10.1007/s11701-016-0600-1

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