Single-port robotic radical cystectomy with ileal conduit urinary diversion: technique and review of the early outcomes in literature

Abstract

The introduction of the da Vinci single port (SP) surgical system (Intuitive Surgical, Sunnyvale, CA, USA) has meant a necessary evolution in the surgical techniques used to perform various Urologic surgeries, such as robotic-assisted radical cystectomy (RARC). In this paper, we describe a step-by-step technique for RARC with intracorporeal ileal conduit urinary diversion using the SP system at our institution and summarize early outcomes in the literature. The surgery was performed utilizing the standard institutional approach for radical cystectomy for the multiport robot, modified for the SP where appropriate. A total of 3 articles were found that included early patient outcomes after SP RARC. Including our institution, a total of 21 patients were included in the final analysis. The average patient age was 68 years old, 16 of the 21 patients were male, 13 of the patients had intracorporeal urinary diversions, the average operative time was 366 min with an average estimated blood loss of 185. The average length of stay was 5.4 days. Among these patients, there were three 30-day complications noted and five 90-day complications, all of which were Clavian II or lower. We conclude that RARC utilizing the SP approach is both feasible and offers several theoretical advantages over the open and multiport approaches, but further study is necessary before advocating for widespread adoption of this modality.

Keywords

Single-port / robotic cystectomy / radical cystectomy / minimally invasive surgery

References

[1] Pignot G,Walz J.Growing evidence for benefits of minimally invasive radical cystectomy.Transl Androl Urol2020;9:2459-61 PMCID:PMC7807372

[2] Vigneswaran HT,Francavilla S,Crivellaro S.A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy.Eur Urol2020;77:671-4

[3] Saidian A,Hakim O,Nix JW.Perioperative outcomes of single vs multi-port robotic assisted radical prostatectomy: a single institutional experience.J Urol2020;204:490-5

[4] Balbay MD,Canda AE.Robot-assisted radical cystectomy: patient selection and special considerations.Robot Surg2017;4:101-6 PMCID:PMC6193425

[5] Kaouk J,Eltemamy M.Single-port robotic intracorporeal ileal conduit urinary diversion during radical cystectomy using the sp surgical system: step-by-step technique.Urology2019;130:196-200

[6] Zhang M,Salama G.Single port robotic radical cystectomy with intracorporeal urinary diversion: a case series and review.Transl Androl Urol2020;9:925-30 PMCID:PMC7214961

[7] Gross JT,Sands KG.Initial experience with single-port robot-assisted radical cystectomy: comparison of perioperative outcomes between single-port and conventional multiport approaches.J Endourol2021;35:1177-83

[8] İnkaya A,Sobay R,Küçük EV.Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer.Turk J Urol2019;45:410-7 PMCID:PMC6788567

[9] Sathianathen NJ,Frydenberg M.Robotic assisted radical cystectomy vs open radical cystectomy: systematic review and meta-analysis.J Urol2019;201:715-20