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Robot-assisted Supratrigonal Cystectomy and Augmentation Cystoplasty with Totally Intracorporeal Reconstruction in Neurourological Patients: Technique Description and Preliminary Results

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Title: Robot-assisted Supratrigonal Cystectomy and Augmentation Cystoplasty with Totally Intracorporeal Reconstruction in Neurourological Patients: Technique Description and Preliminary Results
Authors: J. Parra, Emmanuel Chartier-Kastler, François Crettenand, Nuno Grilo, Pietro Grande, Véronique Phé
Source: European urology, vol. 79, no. 6, pp. 858-865
Publisher Information: Elsevier BV, 2021.
Publication Year: 2021
Subject Terms: Urodynamics, 03 medical and health sciences, 0302 clinical medicine, Urinary Bladder, Overactive, Operative Time, Humans, Urologic Surgical Procedures, Robotics, Cystectomy, Cystectomy/adverse effects, Urinary Bladder, Overactive/surgery, Urologic Surgical Procedures/adverse effects, Augmentation cystoplasty, Neurogenic bladder, Robotic surgery, Supratrigonal cystectomy, 3. Good health
Description: Augmentation cystoplasty as a third-line therapy for neurogenic detrusor overactivity performed by an open approach has long been studied. Few laparoscopic and robot-assisted series have been reported.To evaluate the feasibility, safety, and functional outcomes of completely intracorporeal robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RASCAC) in patients with refractory neurogenic detrusor overactivity.We identified all patients undergoing RASCAC, as treatment for refractory neurogenic detrusor overactivity, from August 2016 to April 2018.RASCAC was performed in all cases using a standardized technique with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration.Perioperative data, and functional and urodynamic results at 1-yr follow-up were assessed. Statistical analysis was performed using Stata version 15.1.Ten patients were identified. No conversion to open surgery was needed. The median operative time was 250 (interquartile range 210-268) min, the median estimated blood loss was 75 (50-255) ml, and the median hospitalization time was 12 (10.5-13) d. The 30-d major complication rate was 10%. Two patients presented a late urinary fistula; in one of the cases, surgical revision was needed. In both cases, low compliance to intermittent self-catheterization was identified. At 1-yr follow-up, functional and urodynamic outcomes were excellent.Robot-assisted augmentation cystoplasty has been shown to be safe and feasible, with a reasonable operative time and low complication rate in experienced hands. A higher number of patients and longer follow-up are, however, warranted to draw definitive conclusions.In this report, we look at the outcomes of robot-assisted supratrigonal cystectomy and augmentation cystoplasty in neurourological patients. Perioperative, functional, and urodynamic results are promising. Further studies with a longer follow-up are needed to confirm these findings.
Document Type: Article
File Description: application/pdf
Language: English
ISSN: 0302-2838
DOI: 10.1016/j.eururo.2020.08.005
Access URL: https://pubmed.ncbi.nlm.nih.gov/33019999
https://www.sciencedirect.com/science/article/pii/S0302283820306229
https://www.europeanurology.com/article/S0302-2838(20)30622-9/fulltext
https://www.ncbi.nlm.nih.gov/pubmed/33019999
https://pubmed.ncbi.nlm.nih.gov/33019999/
https://serval.unil.ch/resource/serval:BIB_4FADA7C363A9.P001/REF.pdf
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_4FADA7C363A91
https://serval.unil.ch/notice/serval:BIB_4FADA7C363A9
Rights: CC BY
Accession Number: edsair.doi.dedup.....65f47b4e7f504b956efed9bd43508cd5
Database: OpenAIRE
Description
Abstract:Augmentation cystoplasty as a third-line therapy for neurogenic detrusor overactivity performed by an open approach has long been studied. Few laparoscopic and robot-assisted series have been reported.To evaluate the feasibility, safety, and functional outcomes of completely intracorporeal robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RASCAC) in patients with refractory neurogenic detrusor overactivity.We identified all patients undergoing RASCAC, as treatment for refractory neurogenic detrusor overactivity, from August 2016 to April 2018.RASCAC was performed in all cases using a standardized technique with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration.Perioperative data, and functional and urodynamic results at 1-yr follow-up were assessed. Statistical analysis was performed using Stata version 15.1.Ten patients were identified. No conversion to open surgery was needed. The median operative time was 250 (interquartile range 210-268) min, the median estimated blood loss was 75 (50-255) ml, and the median hospitalization time was 12 (10.5-13) d. The 30-d major complication rate was 10%. Two patients presented a late urinary fistula; in one of the cases, surgical revision was needed. In both cases, low compliance to intermittent self-catheterization was identified. At 1-yr follow-up, functional and urodynamic outcomes were excellent.Robot-assisted augmentation cystoplasty has been shown to be safe and feasible, with a reasonable operative time and low complication rate in experienced hands. A higher number of patients and longer follow-up are, however, warranted to draw definitive conclusions.In this report, we look at the outcomes of robot-assisted supratrigonal cystectomy and augmentation cystoplasty in neurourological patients. Perioperative, functional, and urodynamic results are promising. Further studies with a longer follow-up are needed to confirm these findings.
ISSN:03022838
DOI:10.1016/j.eururo.2020.08.005