Genitalia Preserving Robotic Radical Cystectomy with Intracorporeal Studer Pouch Formation in the Female: Experience in 5 Cases

Figures & data

Figure 1 Steps of the operation. (A) Completed robot-assisted laparoscopic radical cystectomy with preservation of uterus and ovaries (arrows). (B) Appearance of extended pelvic lymph node dissection. Arrows: abdominal aorta and associated major vasculature. (C) Appearance of completed intracorporeal Studer pouch distended with sterile saline solution (arrow).

Table 1 Patient Characteristics Including Demographics, Operative-Postoperative Parameters, Pathologic Parameters, Complications and Functional Outcomes

	Case 1	Case 2	Case 3	Case 4	Case 5
Patient age: (years)	57	59	63	78	39
BMI: (kg/m^2)	40	26	35	24	24
ASA Score:	3	2	2	3	1
Previous abdominal surgery history:	None	Appendectomy, Cesarean section	Laparoscopic cholecystectomy	Appendectomy	Abdominoplasty
Co-morbid diseases:	Hypertension	None	Hypertension	Hypertension	None
Smoking history:	1 package/day (40 years)	None	None	1 package/day (20 years)	None
Presence of any type of preoperative urinary incontinence:	None	None	None	Urgency incontinence	None
Premenopausal/Postmenopausal state:	Postmenopausal	Postmenopausal	Postmenopausal	Postmenopausal	Premenopausal
Bilateral NVB-sparing:	Yes	Yes	Yes	Yes	Yes
Anomalies detected during surgery:	None	None	None	Severe intra-peritoneal adhesions	Tumor infiltration into pelvic bone
Estimated blood loss: (mL)	800	150	400	950	50
Bilateral extended lymph node dissection:	Yes	Yes	Yes	Yes	Yes
Lymph node yield: n	39	30	30	43	20
Urinary diversion:	Intracorporeal	Intracorporeal	Intracorporeal	Intracorporeal	Intracorporeal
Urinary diversion type:	Studer	Studer	Studer	Studer	Studer
Concomitant robotic surgery:	Right radical nephroureterectomy	None	None	None	None
Operative time: (min)	440 + 130 (nephroureterectomy time including patient repositioning and robot dedocking and re-docking)	370	480	540	480
Overall (hours):	9.5	6.2	8	9	8
Radical cystectomy:	150 min	110 min	150 min	170	190
Bilateral extended lymph node dissection:	110 min	90 min	130 min	210	120
Intracorporeal Studer pouch reconstruction:	180 min	170 min	200 min	160	170
Pathologic stage (PT):	pT3	pTis	pT1	pT4a	pT4b
Number of metastatic lymph nodes: n	5	0	0	2	0
Surgical margins:	Negative	Negative	Negative	Positive	Positive
Time to liquid diet: (days)	1	2	2	3	2
Time to regular diet: (days)	6	3	3	7	3
Time to ambulation: (days)	1	3	2	3	1
Abdominal drain removal time: (days)	6	7	7	8	8
Length of hospital stay: (days)	6	8	8	13	9
Follow-up: (months)	24	10	7	26	7
Complications due to modified Clavien Classification:
0–30 day (Perioperative period)
Minor complication (Grade 1 and 2): n	1: UTI	2: Abdominal pain and UTI	None	Abdominal pain and UTI	Abdominal pain
Major complication (Grade 3–5): n	None	None	None	None	None
31–90 day period
Minor complication (Grade 1 and 2): n	None	None	None	None	None
Major complication (Grade 3–5): n	None	None	Post-renal kidney failure	None	None
Postoperative readmission rates
0–30 day (Perioperative period)
Due to minor complications: n	None	None	None	None	None
Due to major complications: n	None	None	None	None	None
31–90 day period
Due to minor complications: n	None	None	None	None	None
Due to major complications: n	None	None	Bilateral double J stents were inserted	None	None
Postoperative urinary continence evaluation:
Day-time incontinence: (None/Mild/Moderate/Severe)	Moderate (urge incontinence)	Mild (urge incontinence)	None	Moderate (urge incontinence)	None
Night-time incontinence: (Good/Fair/Poor)	Fair	Fair	Fair	Poor	Good
Current sexual function:	Sexually inactive	Sexually inactive	Sexually inactive	Sexually inactive	Sexually inactive