Advertisement

Preliminary Surgical Outcomes After Single Incision Robotic Cystectomy (SIRC)

  • Mark D. Tyson
    Correspondence
    Address correspondence to: Mark D. Tyson, M.D., M.P.H., Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054.
    Affiliations
    Department of Urology, Mayo Clinic, Phoenix, AZ

    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
    Search for articles by this author
  • Lanyu Mi
    Affiliations
    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, Scottsdale, AZ
    Search for articles by this author
Published:November 16, 2022DOI:https://doi.org/10.1016/j.urology.2022.08.061

      Abstract

      Objective

      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.

      Methods

      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.

      Results

      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 7 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 2 cohorts (SIRC: 81.4; converted: 77.0; P = .64).

      Conclusion

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bochner BH.
        • Dalbagni G
        • Sjoberg DD.
        • et al.
        Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial.
        Eur Urol. 2015; 67: 1042
        • Parekh DJ
        • Reis IM
        • Castle EP
        • et al.
        Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial.
        Lancet. 2018; 391: 2525
        • Mastroianni R.
        • Ferriero M.
        • Tuderti G
        • et al.
        Open radical cystectomy versus robot-assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a single center randomised controlled trial.
        J Urol. 2022; 207(5) (101097JU0000000000002422): 982-992
        • Catto JWF
        • Khetrapal P
        • Ricciardi F
        • et al.
        Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: a randomized clinical trial.
        JAMA. 2022; 327(21): 2092-2103
        • Lenfant L
        • Sawczyn G
        • Aminsharifi A
        • et al.
        Pure single-site robot-assisted radical prostatectomy using single-port versus multiport robotic radical prostatectomy: a single-institution comparative study.
        Eur Urol Focus. 2021; 7: 964
        • Glaser ZA
        • Burns ZR
        • Fang AM
        • et al.
        Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements.
        J Robot Surg. 2022; 16(3): 695-703
        • Skinner E.
        Society of Urologic Oncology: Whitmore Lecture.
        Presented at the American Urological Association, New Orleans2022 (May 14th 2022)
        • Tyson M.
        • Andrews P.
        • Cheney S.
        • et al.
        Single incision robotic cystectomy and hybrid orthotopic neobladder reconstruction: a step by step description.
        Urology. 2021; 156: 285
        • Tyson M.
        Robotic Cystectomy Has Not Lived Up to the Hype—Except Perhaps in One Very Important Way.
        American Urological Association News, Linthicum, MD2022
      1. Administration, USFD: da Vinci surgical system, model sp1098, endowrist sp instruments, and accessories., 2020

        • Kaouk J
        • Garisto J
        • Eltemamy M
        • et al.
        Single-port robotic intracorporeal ileal conduit urinary diversion during radical cystectomy using the SP surgical system: step-by-step technique.
        Urology. 2019; 130: 196
        • Ali D
        • Sawhney R
        • Billah M
        • et al.
        Single-port robotic radical cystectomy with intracorporeal bowel diversion: initial experience and review of surgical outcomes.
        J Endourol. 2022; 36: 216
        • Gross JT
        • Vetter JM
        • Sands KG
        • et al.
        Initial experience with single-port robot-assisted radical cystectomy: comparison of perioperative outcomes between single-port and conventional multiport approaches.
        J Endourol. 2021; 35: 1177