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Florence robotic intracorporeal neobladder (Flo RIN ): a new reconfiguration strategy developed following the IDEAL guidelines
Author(s) -
Minervini Andrea,
Vanacore Davide,
Vittori Gianni,
Milanesi Martina,
Tuccio Agostino,
Siena Giampaolo,
Campi Riccardo,
Mari Andrea,
Gavazzi Andrea,
Carini Marco
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14077
Subject(s) - anastomosis , medicine , surgery , interquartile range , urinary diversion , cystectomy , bladder cancer , cancer
Objective To describe our step‐by‐step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, according to the Idea, Development, Exploration, Assessment, Long‐term follow‐up ( IDEAL ) Collaboration guidelines. Patients and Methods The Florence robotic intracorporeal neobladder (Flo RIN ) was performed employing the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro‐ileal anastomosis creating an asymmetrical ‘U’‐shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an ‘L’; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero‐enteral ‘orthotopic’ bilateral anastomosis. The conception and development of the Flo RIN followed the IDEAL guidelines recommended stages: Phase 1 (simulation) involved the neobladder robotic configuration using silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardisation in 15 consecutive robotic approaches. Phase 2a and 2b included urodynamics and imaging assessment of the patients treated. Results From February 2016 to September 2017 Flo RIN was performed in 18 patients. Comparing the first three (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartile range [ IQR ]) reconstruction operating time was 260 (220–340) vs 160 (150–210) min, respectively. Postoperative surgical complications occurred in four of the 18 patients (22.1%), including one surgical Clavien–Dindo Grade III and three Grade I, postoperative medical Clavien–Dindo Grade II complications occurred in three (16.7%) patients. On urodynamic examination (available in nine [50%] patients) the median ( IQR ) reservoir cystometric capacity, compliance, and post‐void residual were 240 (220–267) mL , 18 (12.5–19.8) mL /cmH 2 O, and 0 (0–50) mL , respectively. Ultrasonography showed no Grade ≥2 vesico‐ureteric reflux. Conclusion We describe the Flo RIN configuration, showing its technical feasibility with acceptable time efficiency. The first cases studied had good reservoir capacity, low pressure with no reflux, and complete voiding.