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Minerva Urologica e Nefrologica 2018 April;70(2):193-201

DOI: 10.23736/S0393-2249.17.02970-8


language: English

Robot assisted radical cystectomy with totally intracorporeal urinary diversion: initial, single-surgeon’s experience after a modified modular training

Angelo PORRECA 1, Francesco CHESSA 2 , Daniele ROMAGNOLI 2, Antonio SALVAGGIO 1, Angelo CAFARELLI 1, Marco BORGHESI 2, Lorenzo BIANCHI 2, Matteo DANDREA 1, Daniele D'AGOSTINO 1, Donato DENTE 1, Emanuele CAPPA 1, Peter WIKLUND 3, Eugenio BRUNOCILLA 2, Riccardo SCHIAVINA 2

1 Department of Urology, Policlinico di Abano, Abano Terme, Padua, Italy; 2 Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; 3 Department of Urology, Karolinska Institute, Stockholm, Sweden


BACKGROUND: To report the perioperative and early functional outcomes of patients undergoing Robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion performed by a single surgeon after a modified modular training.
METHODS: The surgeon (A.P.) attained a 30-days modified modular training at a referring Center mentored by a worldwide-recognized robotic surgeon (P.W.). The training program consisted of: 1) e-learning based on 10 hours of theoretical lessons made by the mentor; 2) video-session concerning the different steps of the procedure, 3) step-by-step in vivo modular training. Demographics, intraoperative data and post-operative complications were recorded for each patient.
RESULTS: Twenty-four consecutive patients were prospectively evaluated. Median age was 68.5 years (IQR 59-75). Thirteen (54.2%) and 11 (45.8%) patients received RARC with orthotopic neobladder (ONB) and ileal conduit (IC), respectively. Overall mean (±SD) operative time was 392 (± 34.8) minutes. The median number of lymph node retrieved was 30 (IQR 24-42), the mean intraoperative estimated blood loss (EBL) was 403 mL (±60) with average hospitalization of 7.8 days (±2.2). All procedures were completed successfully without open conversion. A statistically significant difference in terms of overall operative time (OT) and urinary diversion operative time (UDOT) was found in favor of IC group compared to ONB group (P=0.002). Overall complication rate was 33%, 7 out of 9 (88%) were graded as minor (Clavien 1-2). Two (22%) major complications (Clavien 3-5) occurred solely on ONB group.
CONCLUSIONS: Robot-assisted radical cystectomy with totally intracorporeal urinary diversion is a challenging procedure with a steep learning curve. An adequate modular training with an experienced mentor and a skilled robotic team could be essential to reach these optimal results. Further studies investigating the impact of modular learning curve and a dedicated menthorship on operative and functional outcomes after RARC are needed.

KEY WORDS: Robotics - Cystectomy - Learning curve - Outcome assessment, health care

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