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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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Minerva Urologica e Nefrologica 2017 Nov 21

DOI: 10.23736/S0393-2249.17.02970-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

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, Italy; 2 Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy: 3 Department of Urology, Karolinska Institute, Stockholm, Sweden


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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 Centre mentored by a worldwide-recognized robotic surgeon (P.W.). The training program consisted of: a) e-learning based on 10 hours of theoretical lessons made by the mentor; b) video-session concerning the different steps of the procedure, c) 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 favour 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: Robotic - Cystectomy - Training programs

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Publication History

Article first published online: November 21, 2017
Manuscript accepted: November 8, 2017
Manuscript revised: October 4, 2017
Manuscript received: May 9, 2017

Cite this article as

Porreca A, Chessa F, Romagnoli D, Salvaggio A, Cafarelli A, Borghesi M, et al. Robot assisted radical cystectomy with totally intracorporeal urinary diversion: initial, single surgeon’s experience after a modified modular training. Minerva Urol Nefrol 2017 Nov 21. DOI: 10.23736/S0393-2249.17.02970-8

Corresponding author e-mail

francesco.chessa2@studio.unibo.it