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OBJECTIVE: To review the most used robot-assisted cutaneous urinary diversion (CUD) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images. METHODS: A non-systematic review of the literature with the keywords "bladder cancer", "cutaneous urinary diversion", and "radical cystectomy" was performed. RESULTS: Twenty-four studies of intracorporeal ileal conduit (ICIC) and two of intracorporeal Indiana pouch (ICIP) were included in the analysis. Regarding ICIC, the patients' age ranged from 60 to 76 years. The operative time to perform a urinary diversion ranged from 60 to 133 min. The total estimated blood loss ranged from 200 to 1 117 mL. The rate of positive surgical margins ranged from 0% to 14.3%. Early minor and major complication rates ranged from 0% to 71.4% and from 0% to 53.4%, respectively. Late minor and major complication rates ranged from 0% to 66% and from 0% to 32%, respectively. Totally ICIP data are limited to one case report and one clinical series. CONCLUSION: The most frequent type of CUD is ICIC. Randomized studies comparing the performance of the different types of CUD, the performance in an intra- or extracorporeal manner, or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature. To this day, there are not enough quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images for each technique.
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ABSTRACT: To review the most used intracorporeal orthotopic ileal neobladder (ICONB) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images. METHODS: We performed a non-systematic review of the literature with the keywords "bladder cancer", "urinary diversion", "radical cystectomy", and "neobladder". RESULTS: Forty studies were included in the analysis. The most frequent type of ICONB was the modified Studer "U" neobladder (70%) followed by the Hautmann "W" modified neobladder (7.5%), the "Y" neobladder (5%), and the Padua neobladder (5%). The operative time to perform a urinary diversion ranged from 124 to 553 min. The total estimated blood loss ranged from 200 to 900 mL. The rate of positive surgical margins ranged from 0% to 8.1%. Early minor and major complication rates ranged from 0% to 100% and from 0% to 33%, respectively. Late minor and major complication rates ranged from 0% to 70% and from 0% to 25%, respectively. CONCLUSION: The most frequent types of ICONB are Studer "U" neobladder, Hautmann "W" neobladder, "Y" neobladder, and the Padua neobladder. Randomized studies comparing the performance of the different types of ICONB, the performance in an intra or extracorporeal manner, or the performance of an ICONB versus ICIC are lacking in the literature. To this day, there are not sufficient quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images of each technique.
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INTRODUCCIÓN: La cirugía robótica es una técnica en aumento tanto en Chile como en el mundo. Una de las áreas de la medicina que ha sido pionera en la introducción de esta nueva técnica es Urología, dónde ha crecido el interés en torno a la utilización de la cirugía robótica en cáncer de vejiga músculo invasor(CVMI). El objetivo de esta revisión es examinar la bibliografía disponible sobre el tema. MÉTODOS: Se realizó una búsqueda no sistemática de la literatura utilizando la base de datos de Pubmed y MGH Treadwell library. En estas se utilizaron las palabras claves "Bladder cancer", Muscle-invasive bladder cancer", "Blader cancer epidemiology" , "Radical cistectomy" "Robot-assisted radical cistectomy", ¨Robotic surgery urology¨. Se aplicaron límites de publicaciones dentro de los últimos 10 años. DISCUSIÓN: El cáncer vesical es una enfermedad de alta prevalencia, aproximadamente el 25 % de ellos se presentan con CVMI al momento del diagnóstico. El tratamiento de estándar actualmente para CVMI la cistectomía radical con linfadenectomía pélvica extendida, derivación urinaria y quimioterapia neoadyuvante en ciertos casos. Buscando dar solución a las complicaciones de esta cirugía, surge el interés por utilizar la cirugía robótica en el tratamiento de CVMI a través de la cistectomía radical asistida por robot(CRAR). Actualmente se han publicado estudios con resultados que indican disminución de la morbilidad perioperatoria y menor estadía hospitalaria, manteniendo la eficacia oncológica de este procedimiento versus la cistectomía radical abierta(CRA). Otros estudios no han encontrado diferencias significativas entre las dos técnicas en cuanto a complicaciones. CONCLUSIÓN: Aún existe insuficiente experiencia y evidencia del uso de esta en cáncer de vejiga músculo-invasor pero los resultados actuales tienden a resultados no inferiores y positivos en cuanto a la CRAR versus la CRA.AU
METHODS: We performed a non-systematic literature search using the Pubmed and MGH Treadwell library database. Key words "Bladder cancer", Muscle-invasive bladder cancer", "Bladder cancer epidemiology" , "Radical cystectomy" "Robot-assisted radical cystectomy", ¨Robotic surgery urology¨. were used. Limits of publications were applied within the last 10 years. DISCUSSION: Bladder cancer is a highly prevalent disease. Approximately 25% of patients present with MIBC at the time of diagnosis. The standard treatment currently for CVMI is radical cystectomy with extended pelvic lymphadenectomy, urinary diversion and neoadjuvant chemotherapy in certain cases. In order to solve the complications of this surgery, there is an interest in the use of robotic surgery in the treatment of MIBC through robot assisted radical cystectomy (RARC). Studies with results indicating decreased perioperative morbidity and shorter hospital stay have been published, maintaining the oncological efficacy of this procedure versus open radical cystectomy (ORC). Other studies have found no significant difference between the two techniques in terms of complications. CONCLUSION: There is still insufficient experience and evidence of its use in m