SpringerLink
Log in

Comparison of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy at a medium-sized facility

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study is to compare the perioperative outcomes and learning curves between intracorporeal and extracorporeal urinary diversion at our medium-sized institution.

Methods

Between January 2018 and September 2020, a single surgeon at our institution performed 46 consecutive robot-assisted radical cystectomies with ileal conduit. We compared the perioperative outcomes between patients who underwent intracorporeal versus extracorporeal urinary diversion. We also investigated learning curves for the first and last 10 patients in each group.

Results

The extracorporeal group had shorter overall operative time (P = 0.003) and urinary diversion time (P < 0.0001) than the intracorporeal group. The intracorporeal group had shorter length of hospital stay (P = 0.02). There was no difference in complication and readmission rates. The extracorporeal group demonstrated no difference between the first and last 10 patients for overall operative time or time for cystectomy, lymph node dissection, or urinary diversion. However, the intracorporeal group had shorter urinary diversion time for the last 10 patients compared with the first 10 patients. The first 10 patients in the extracorporeal group had shorter overall operative time than the first 10 in the intracorporeal group, but there was no difference for the last 10 patients.

Conclusions

Intracorporeal urinary diversion requires longer overall operative time than extracorporeal diversion for the first 10 patients, due to longer urinary diversion time. However, there is no difference in overall operative time for the last 10 patients. The benefit of intracorporeal over extracorporeal urinary diversion was not confirmed at our medium-sized institution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol 19:666–675

    Article  CAS  Google Scholar 

  2. Gore JL, Litwin MS, Lai J et al (2010) Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst 102:802–811

    Article  Google Scholar 

  3. Iwata T, Kimura S, Foerster B et al (2019) Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis. World J Urol 37:1557–1570

    Article  Google Scholar 

  4. Kimura S, Iwata T, Foerster B et al (2019) Comparison of perioperative complications and health-related quality of life between robot-assisted and open radical cystectomy: a systematic review and meta-analysis. Int J Urol 26:760–774

    Article  Google Scholar 

  5. Hayn MH, Hussain A, Mansour AM et al (2010) The learning curve of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 58:197–202

    Article  Google Scholar 

  6. Hussein AA, May PR, **g Z et al (2018) Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. J Urol 199:1302–1311

    Article  Google Scholar 

  7. Zhang JH, Ericson KJ, Thomas LJ et al (2020) Large single institution comparison of perioperative outcomes and complications of open radical cystectomy, intracorporeal robot-assisted radical cystectomy and robotic extracorporeal approach. J Urol 203:512–521

    Article  Google Scholar 

  8. Hussein AA, Elsayed AS, Aldhaam NA et al (2020) A comparative propensity score-matched analysis of perioperative outcomes of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. BJU Int 126:265–272

    Article  Google Scholar 

  9. Pyun JH, Kim HK, Cho S et al (2016) Robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparative analysis with extracorporeal urinary diversion. J Laparoendosc Adv Surg Tech A 26:349–355

    Article  Google Scholar 

  10. Iwamoto H, Yumioka T, Yamaguchi N et al (2016) Robot-assisted radical cystectomy is a promising alternative to open surgery in the Japanese population with a high rate of octogenarians. Int J Clin Oncol 21:756–763

    Article  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  12. Bricker EM (1950) Bladder substitution after pelvic evisceration. Surg Clin North Am 30:1511–1521

    Article  CAS  Google Scholar 

  13. Wallace DM (1970) Uretero-ileostomy. Br J Urol 42:529–534

    Article  CAS  Google Scholar 

  14. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  15. Goh AC, Gill IS, Lee DJ et al (2012) Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol 62:891–901

    Article  Google Scholar 

  16. Wilson TG, Guru K, Rosen RC, Pasadena Consensus Panel et al (2015) Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel. Eur Urol 67:363–375

    Article  Google Scholar 

  17. Bertolo R, Agudelo J, Garisto J et al (2019) Perioperative outcomes and complications after robotic radical cystectomy with intracorporeal or extracorporeal ileal conduit urinary diversion: head-to-head comparison from a single-institutional prospective study. Urology 129:98–105

    PubMed  Google Scholar 

  18. Filson CP, Tan HJ, Chamie K et al (2016) Determinants of radical cystectomy operative time. Urol Oncol 34:431.e17–24. https://doi.org/10.1016/j.urolonc.2016.05.006

    Article  Google Scholar 

  19. Dason S, Goh AC (2018) Contemporary techniques and outcomes of robotic cystectomy and intracorporeal urinary diversions. Curr Opin Urol 28:115–122

    Article  Google Scholar 

  20. Collins JW, Tyritzis S, Nyberg T et al (2014) Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder - what is the effect of the learning curve on outcomes? BJU Int 113:100–107

    Article  Google Scholar 

  21. Porreca A, Bianchi FM, Romagnoli D et al (2020) Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center. J Robot Surg 14:261–269

    Article  CAS  Google Scholar 

  22. Koie T, Ohyama C, Makiyama K et al (2019) Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer. Int J Urol 26:334–340

    Article  Google Scholar 

  23. Kingo PS, Nørregaard R, Borre M et al (2017) Postoperative C-reactive protein concentration and clinical outcome: comparison of open cystectomy to robot-assisted laparoscopic cystectomy with extracorporeal or intracorporeal urinary diversion in a prospective study. Scand J Urol 51:381–387

    Article  CAS  Google Scholar 

  24. Tamhankar AS, Ahluwalia P, Patil SR et al (2020) Implementation of ERAS protocol in robot-assisted radical cystectomy with intracorporeal ileal conduit urinary diversion: an outcome analysis beyond the learning curve. Indian J Urol 36:37–43

    PubMed  PubMed Central  Google Scholar 

  25. Tan TW, Nair R, Saad S et al (2019) Safe transition from extracorporeal to intracorporeal urinary diversion following robot-assisted cystectomy: a recipe for reducing operative time, blood loss and complication rates. World J Urol 37:367–372

    Article  Google Scholar 

  26. Yin M, Joshi M, Meijer RP et al (2016) Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis. Oncologist 21:708–715

    Article  CAS  Google Scholar 

  27. Dell’Oglio P, Mazzone E, Lambert E et al (2021) the effect of surgical experience on perioperative and oncological outcomes after robot-assisted radical cystectomy with intracorporeal urinary diversion: evidence from a referral centre with extensive experience in robotic surgery. Eur Urol Focus 7:352–358

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank all of the da Vinci surgical team at Okayama university hospital.

Author information

Authors and Affiliations

  1. Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama-City, Okayama, 700-8558, Japan

    Takehiro Iwata, Yasuyuki Kobayashi, Yuki Maruyama, Tatsushi Kawada, Takuya Sadahira, Yuko Oiwa, Satoshi Katayama, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Koichiro Wada, Kohei Edamura, Motoo Araki, Masami Watanabe, Toyohiko Watanabe & Yasutomo Nasu

  2. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Satoshi Katayama

Authors
  1. Takehiro Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuyuki Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Maruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsushi Kawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takuya Sadahira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuko Oiwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Satoshi Katayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shingo Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Atsushi Takamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomoko Sako
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Koichiro Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kohei Edamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Motoo Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masami Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Toyohiko Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yasutomo Nasu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuyuki Kobayashi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All the procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Okayama University Institutional Review Board prior to study initiation (Approval number: 2009-022).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwata, T., Kobayashi, Y., Maruyama, Y. et al. Comparison of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy at a medium-sized facility. Int J Clin Oncol 26, 1714–1721 (2021). https://doi.org/10.1007/s10147-021-01957-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-021-01957-1

Keywords

Search

Navigation