Intracorporeal Urinary Diversion of Robot-Assisted Radical Cystectomy

Abstract

With the widespread utilization of robot-assisted radical cystectomy (RARC) that demonstrated non-inferiority compared to open radical cystectomy in terms of several outcomes, urinary diversions are now performed for both extracorporeal and intracorporeal procedures. The potential benefits of intracorporeal urinary diversion (ICUD) include smaller incisions, reduced pain, reduced intraoperative blood loss, reduced bowel handling and exposure, and third space loss. ICUD following radical cystectomy requires many steps and a careful stepwise progression. Surgical volumes (RARCs per year) per center and per surgeon appear to be correlated with a reduction in complications. The European Association of Urology guidelines recommend that hospitals should perform at least 10, and preferably more than 20 operations annually. With the aim of generalizing ICUD, this chapter will discuss the following items: (1) Technique of intracorporeal ileal conduit; (2) Perioperative comparison of intracorporeal and extracorporeal urinary diversion in RARC; (3) Hybrid technique in robot-assisted intracorporeal ileal conduit; and (4) Intracorporeal ileal neobladder.