Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer.

Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder. Robot-assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot-assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high-volume academic institutions. In the present review, we compare the totally intracorporeal robot-assisted radical cystectomy approach with open radical cystectomy and robot-assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle-invasive bladder cancer patients.

International journal of urology : official journal of the Japanese Urological Association. 2019 Jan 28 [Epub ahead of print]

Takuya Koie, Chikara Ohyama, Kazuhide Makiyama, Toru Shimazui, Tomoaki Miyagawa, Kosuke Mizutani, Tomohiro Tsuchiya, Taku Kato, Keita Nakane

Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan., Department of Urology, Yokohama City University, Yokohama, Kanagawa, Japan., Department of Urology, Ibaraki Clinical Education and Training Center, Faculty of Medicine, University of Tsukuba, Kasama, Ibaraki, Japan., Depatment of Urology, Jichi Medical University Saitama Medical Center, Urawa, Saitama, Japan.