Initial Experience of Hybrid Technique in Robot-Assisted Intracorporeal Ileal Conduit

OBJECTIVE: This study was designed to describe our hybrid approach to intracorporeal urinary diversion and evaluate surgical experience during initial induction. MATERIAL AND METHODS: Clinical data from 38 patients with bladder cancer undergoing robot-assisted radical cystectomy with ileal conduit hybrid approach to intracorporeal urinary diversion at our institution between May 2020 and January 2022 were reviewed. The hybrid approach to intracorporeal urinary diversion procedure involved the following: radical cystectomy, removing a specimen through a 4- to 6-cm skin incision, harvesting an ileal conduit, redocking the robot, and uretero–uretero anastomosis. The relationship between surgical experience and operative time and a Clavien–Dindo classification of grade >3 was evaluated. RESULTS: Of the 38 patients, 30 (79%) were male, and the median age was 75 years (interquartile range, 71-80 years). The total operative time was 384 minutes (interquartile range, 348-409 minutes). The estimated blood loss was 244 mL (interquartile range, 124-445 mL). No bowel injuries or conversions to laparoscopy or laparotomy were encountered. High-grade postoperative complications (Clavien–Dindo classification grade > 3) occurred in 7 cases (19%). The overall 90-day readmission rate following discharge after surgery was 5%. The relationship between surgical experience and operative time was nonlinear. A plateau was not reached in all 38 patients. CONCLUSION: Our hybrid approach to intracorporeal urinary diversion technique can be accomplished safely with acceptable operative times, even with little surgical experience. This procedure might be a safe treatment option that is relatively easy to perform, particularly in an institution that has not yet introduced intracorporeal urinary diversion. Future randomized trials with larger samples and longer follow-up periods are required to confirm our findings.