INITIAL EXPERIENCE WITH ROBOT-ASSISTED RADICAL CYSTECTOMY AND INTRACORPOREAL URINARY DIVERSION ~COMPARISON WITH THE CONVENTIONAL METHOD~

: (Objectives) While robot assisted radical cystectomy (RARC) has been associated with improved perioperative outcomes such as blood loss, hospital stay, and improved convalescence, much of the criticism has been attributable to the longer operative time. Opinions are divided regarding whether intracorporeal urinary diversion (ICUD) or extracorporeal urinary diversion (ECUD) should be performed. The aim of this study is to evaluate the utility of RARC and ICUD by comparing with the conventional method. (Patients and methods) From December 2014 to July 2018, 14 patients underwent laparoscopic radical cystectomy (LRC) and 16 patients underwent RARC at our institution. Among the 30 patients, 23 underwent ileal conduit or orthotopic bladder; these patients were divided into two groups: an ICUD patient group (n=10) and an ECUD patient group (n=13). Treatment outcomes were compared between groups. (Results) Compared to patients who underwent LRC those treated with RARC had older (75 vs. 67, P=0.031). There was a trend of high-risk cases (American Society of Anesthesiologists' physical status classification ≥3) more frequently (31.3% vs. 7.1%, P=0.176). Patient treated with RARC had less blood loss (150 vs. 544 ml, P=0.003). There was no significant difference in the intra- and postoperative complication rates (12.5% vs. 21.4%, P=0.642). Compared to patients who underwent ECUD, those treated with ICUD included a longer operative time for urinary diversion (222 vs. 181 minutes, P=0.007) but less maximal incision length without perineal incision (3.0 vs. 6.0 cm, P=0.002). (Conclusions) Our data suggests that RARC is a safe procedure with potential advantages in terms of reduced blood loss. ICUD has longer operative time but is a procedure with excellent cosmetic results.