Robot-Assisted Approach to W Configuration Urinary Diversion:A Step-by-Step Technique.

Hussein, A. A., Y. E. Ahmed, J. D. Kozlowski, P. May, J. Nyquist, S. Sexton, L. Curtin, J. O. Peabody, H. Abol-Enein, and K. A. Guru, "Robot-Assisted Approach to W Configuration Urinary Diversion:A Step-by-Step Technique.", BJU international, 2017 Feb 20.


INTRODUCTION: To describe a detailed step-by-step approach of our technique to robot-assisted intracorporeal "W" orthotopic ileal neobladder (ICNB).

METHODS: Five patients underwent robot-assisted radical cystectomy (RARC), extended pelvic lymph node dissection (ePLND) and ICNB. ICNB was divided into 6 key steps to facilitate and enable a detailed analysis and auditing of the technique. No conversion to open surgery was required. Timing for each step was noted. All patients had at least 3 months of follow up.

RESULTS: Mean age was 57 years. Mean overall console and diversion times were 357 and 193 minutes, respectively. None of the patients had any evidence of residual disease following RARC. Four of five patients experienced complications; 3 developed fevers due to urinary tract infection (one required readmission), and 1 patient developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularization and construction of posterior plate were consistently the longest among the key steps (average 46 minutes, 13% of the overall operative time), followed by uretero-ileal anastomosis (37 minutes, 10%), neobladder-urethral anastomosis (23 minutes, 6%) and identification and fixation of the bowel (26 minutes, 7%).

CONCLUSION: We described our step-by-step technique and initial perioperative outcomes of our first five intracorporeal neobladders with "W" configuration This article is protected by copyright. All rights reserved.