Efficacy of intracorporeal versus extracorporeal urinary diversion with robot-assisted laparoscopic radical cystectomy: an analysis of 54 cases

Abstract

Objective To compare the clinical efficacy of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) with robot-assisted laparoscopic radical cystectomy (RARC). Methods A retrospective analysis was carried out on the patients who were diagnosed with muscle invasive bladder cancer (MIBC) and received RARC in our hospital from January 2019 to June 2020. According to the different urinary diversion adopted during the operation, they were divided into complete internal urinary diversion (ICUD group, n=18) and external urinary diversion (ECUD group, n=36). The operation time, blood loss amount, number of dissected lymph nodes, time of postoperative intestinal function recovery, length of postoperative hospital stay, time of removing plasma drainage tube, incidence of postoperative complications and rate of postoperative urinary control were compared between the 2 groups. Results RARC surgery successfully performed in all the 54 cases, and none of them were transferred to open surgery. The operation time of ICUD group was 270 (240~320) min, which was significantly shorter than that of ECUD group [330 (295~380) min, P 0.05). Postoperative urethral cystography showed that the new bladders located in normal position, with closely to normal capacity and no obvious ureteral reflux in the 2 groups. There were 2 cases of acute intestinal obstruction and intestinal ischemic necrosis after operation, 1 case of incomplete intestinal obstruction and 1 cases of pulmonary infection in ECUD group, and 1 case of incomplete intestinal obstruction and 2 cases of urinary tract infection in ICUD group. All of these were relieved after corresponding treatment. Conclusion Whether complete ICUD or ECUD can obtain good clinical outcome for RARC, and the former has shorter operation time and shows better advantages of robot-assisted technology.

Keywords

• bladder neoplasms
• robotic surgery system
• intracorporeal urinary diversion
• extracorporeal urinary diversion