Surgical outcomes and perioperative complications of robot-assisted radical cystectomy with intracorporeal ileal neobladder: a narrative review

Abstract

Background and Objective: Complete intracorporeal urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC) offers potential advantages as a minimally invasive procedure. Previous studies indicate that neobladder (NB) reconstruction with ICUD (IC-NB) is a complex surgical procedure associated with longer operative times and higher complication rates compared to ileal conduits. This complexity often deters widespread adoption of this technique because of its steep learning curve. Reports suggest that mastering the IC-NB surgical techniques and achieving favorable surgical outcomes may require surgeons to perform 25-250 cases. Several surgical techniques for IC-NB have been reported over the past decades, including the Padua ileal NB, Vesica Patavina (Ves. Pa.) procedure, Shell NB reconstruction, Florence robotic IC-NB, cross-folded U-configuration IC-NB, Pyramid NB, Karolinska technique, and Studer pouch. The purpose of this narrative review was to identify various studies in patients with bladder cancer who underwent RARC with IC-NB and to introduce the different methods of NB reconstruction, surgical outcomes, perioperative complications, and learning curves in the current state of the art. Methods: For this narrative review, the online databases PubMed and Scopus were used to search for relevant literature. The eligible references included peer-reviewed English-language articles published from August 2009 to May 2024 containing the following Medical Subject Heading terms: "radical cystectomy, robotic surgery, intracorporeal neobladder, outcome, and complications". Key Content and Findings: IC-NB was performed using the ileum in all the techniques. The entire operative time was approximately 5-7 h, estimated blood loss was approximately 350 mL, and transfusion rate was <5%. Readmissions and severe postoperative complications were observed in approximately 30% of patients, and postoperative deaths were reported. Conclusions: From the experience reviewed in this study, it can be concluded that sufficient surgical experience is necessary for surgical outcomes to reach a plateau. Furthermore, institutional experience with robotic surgery may play a pivotal role. Finally, surgical training with the help of experienced surgical tutors may play a crucial role in expediting the learning curve to safely and successfully perform robotic IC-NB procedures.