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

• Published in: Minerva urologica e nefrologica = The Italian journal of urology and nephrology Vol. 70; no. 2; p. 193
• Main Authors: Porreca, Angelo, Chessa, Francesco, Romagnoli, Daniele, Salvaggio, Antonio, Cafarelli, Angelo, Borghesi, Marco, Bianchi, Lorenzo, Dandrea, Matteo, D'Agostino, Daniele, Dente, Donato, Cappa, Emanuele, Wiklund, Peter, Brunocilla, Eugenio, Schiavina, Riccardo
• Format: Journal Article
• Language: English
• Published: Italy 01.04.2018
• Subjects: Aged; Clinical Competence; Cystectomy - methods; Female; Humans; Learning Curve; Male; Middle Aged; Prospective Studies; Robotic Surgical Procedures - methods; Surgeons; Treatment Outcome; Urinary Diversion - methods; Urologic Surgical Procedures - education; Urologic Surgical Procedures - methods; Urology - education
• ISSN: 1827-1758
• DOI: 10.23736/S0393-2249.17.02970-8

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. 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. 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. 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.