To report the preliminary surgical outcomes for single incision robotic cystectomy (SIRC). Robotic cystectomy is associated with low utilization rates of orthotopic neobladders due to challenges related to intracorporeal sowing and configuration. A new technique that shortens the learning curve and reduces the incisional footprint may improve outcomes and lead to greater utilization of neobladders.
Patients undergoing SIRC using the Da Vinci Single Port (SP) robot between March 2021 and March 2022 are included in this retrospective study. We report 30-day perioperative outcomes and test the hypothesis that patients undergoing SIRC have lower analgesic requirements by comparing them to a cohort of patients for whom SIRC was attempted but converted to open during the study period.
Forty-one patients underwent SIRC, with 17 (41%) patients undergoing conversion to open. Of the SIRC patients, 50% underwent orthotopic neobladder reconstruction, and 13% underwent concomitant nephroureterectomy or urethrectomy. The median operative time was 480 minutes, and the median length of hospitalization was seven days. Seventeen percent required readmission to the hospital, 17% developed small bowel obstruction or ileus, and 13% required a blood transfusion. With respect to analgesic requirements, there were no differences in the median morphine milligram equivalents between the two cohorts (SIRC: 81.4; converted: 77.0; p=0.64).
We demonstrate that SIRC is safe and feasible with a high neobladder utilization rate. Wider adoption of this technique may lead to greater utilization of neobladders for patients undergoing robotic cystectomy.
Urology. 2022 Nov 16 [Epub ahead of print]
Mark D Tyson, Lanyu Mi
Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Phoenix, AZ. Electronic address: ., Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Phoenix, AZ; Department of Qualitative Health Sciences, Divisions of Clinical Trials and Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona.