Robot‐assisted approach to ‘W’‐configuration urinary diversion: a step‐by‐step technique

• Published in: BJU international Vol. 120; no. 1; pp. 152 - 157
• Main Authors: Hussein, Ahmed A., Ahmed, Youssef E., Kozlowski, Justen D., May, Paul R., Nyquist, John, Sexton, Sandra, Curtin, Leslie, Peabody, James O., Abol‐Enein, Hassan, Guru, Khurshid A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2017
• Subjects: Anastomosis; Angiography; Biopsy; Cystectomy - methods; Female; Guidelines as Topic; Hautmann; Humans; Ileum - surgery; Intestine; intracorporeal; Lymph; Lymph Node Excision; Lymph nodes; Male; Middle Aged; Myocardial infarction; neobladder; orthotopic urinary diversion; Pelvis; Robotic surgery; Robotic Surgical Procedures; Robots; robot‐assisted radical cystectomy; Surgery; Surgery, Computer-Assisted; Treatment Outcome; Urinary Diversion; Urinary tract; Urinary tract infections; W‐configuration; neobladder; Hautmann; W-configuration; orthotopic urinary diversion; intracorporeal; robot-assisted radical cystectomy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.13824

Objective
To describe a detailed step‐by‐step approach of our technique for robot‐assisted intracorporeal ‘W’‐configuration orthotopic ileal neobladder.
Patients and Methods
Five patients underwent robot‐assisted radical cystectomy (RARC), extended pelvic lymph node dissection and intracorporeal neobladder (ICNB). ICNB was divided into six 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
The mean age was 57 years. The mean overall console and diversion times were 357 and 193 min, respectively. None of the patients had any evidence of residual disease after RARC. Four of the five patients had complications; three developed fevers due to urinary tract infections (one required readmission), and one developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularisation and construction of the posterior plate were consistently the longest among the key steps (average 46 min, 13% of the overall operative time), followed by uretero‐ileal anastomosis (37 min, 10%), neobladder–urethral anastomosis (23 min, 6%), and identification and fixation of the bowel (26 min, 7%).
Conclusion
We described our step‐by‐step technique and initial perioperative outcomes of our first five ICNBs with ‘W’ configuration.