Objective: Robotic intracorporeal neobladder reconstruction is a complex procedure in which the approximation of the reservoir to the urethral stump can be a demanding step. The aim of the study is to evaluate the reproducibility of a modified posterior reconstruction (PR) during the reconfiguration of intracorporeal neobladder after robot assisted radical cystectomy (RARC). Materials and Methods: From July 2021 to July 2022, 35 RARC were performed, and 17 patients underwent intracorporeal neobladder reconstruction. A PR was planned in males (14). Intra and peri-operative data were collected. Surgical technique: RARC and node dissection are performed. Afterwards, 40-cm ileal segment is isolated; the portion with the more adequate mesenteric length is brought down to the pelvis. A modified PR is performed with a double-armed barbed suture: a first layer connects the Denonvillier’s fascia to the rhabdosphincter in a running fashion; the second layer is created with the other arm and approximates the posterior side of the ileal segment towards the urethral stump. In the anterior caudal part of the ileum, a 1.5-cm incision is made to realize the neobladder neck; the neovesical- -urethral anastomosis is performed with a second bidirectional suture. Results: Anastomotic and PR time were 14 (range 7-20) and 5 minutes (4-8), respectively. A single Clavien IIIa complication was recorded in a patient who underwent NAC and had a C. albicans superinfection in the post-operative course. All patients were discharged with complete or acceptable bladder voiding. Twelve patients with follow- -up >90-days reported a satisfying daytime continence. Conclusions: PR represents a simple technical refinement that improves neobladder- -urethral anastomosis by favoring ileal approximation to the urethral stump and decreasing anastomotic tension
Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration / Rocco, B.; Assumma, S.; Calcagnile, T.; Sangalli, M.; Turri, F.; Micali, S.; Gaia, G.; Bozzini, G.; Sighinolfi, M. C.. - In: INTERNATIONAL BRAZ J UROL. - ISSN 1677-5538. - 49:1(2023), pp. 136-142. [10.1590/S1677-5538.IBJU.2022.0417]
Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration
Rocco B.;Assumma S.;Calcagnile T.;Micali S.;Bozzini G.;Sighinolfi M. C.
2023
Abstract
Objective: Robotic intracorporeal neobladder reconstruction is a complex procedure in which the approximation of the reservoir to the urethral stump can be a demanding step. The aim of the study is to evaluate the reproducibility of a modified posterior reconstruction (PR) during the reconfiguration of intracorporeal neobladder after robot assisted radical cystectomy (RARC). Materials and Methods: From July 2021 to July 2022, 35 RARC were performed, and 17 patients underwent intracorporeal neobladder reconstruction. A PR was planned in males (14). Intra and peri-operative data were collected. Surgical technique: RARC and node dissection are performed. Afterwards, 40-cm ileal segment is isolated; the portion with the more adequate mesenteric length is brought down to the pelvis. A modified PR is performed with a double-armed barbed suture: a first layer connects the Denonvillier’s fascia to the rhabdosphincter in a running fashion; the second layer is created with the other arm and approximates the posterior side of the ileal segment towards the urethral stump. In the anterior caudal part of the ileum, a 1.5-cm incision is made to realize the neobladder neck; the neovesical- -urethral anastomosis is performed with a second bidirectional suture. Results: Anastomotic and PR time were 14 (range 7-20) and 5 minutes (4-8), respectively. A single Clavien IIIa complication was recorded in a patient who underwent NAC and had a C. albicans superinfection in the post-operative course. All patients were discharged with complete or acceptable bladder voiding. Twelve patients with follow- -up >90-days reported a satisfying daytime continence. Conclusions: PR represents a simple technical refinement that improves neobladder- -urethral anastomosis by favoring ileal approximation to the urethral stump and decreasing anastomotic tensionPubblicazioni consigliate
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