#247 Perioperative & functional results of RARC with totally intracorporeal neobladder… F. Zattoni

FULL TITLE: Perioperative and functional results of RARC with totally intracorporeal neobladder: the Ves.Pa. technique. Ideal stage 2a report. Dr. F. Zattoni This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

Description from the entry: We report our initial experience with robot-assisted radical cystectomy with intracorporeal neobladder reconstruction according to the Ves.Pa. technique.

ABSTRACT: Perioperative and functional results of RARC with totally intracorporeal neobladder: the Ves.Pa. technique. Ideal stage 2a report. Fabrizio Dal Moro, Fabio Zattoni, Elisa Tonet, Alessandro Morlacco, Giovanni Betto, Giacomo Novara Urology clinic, Department of Surgery, Oncology and Gastroenterology University of Padua, Italy

Abstract: Background: Robot-assisted radical cystectomy (RARC) has been shown to offer several advantages over open surgery, including reduced blood loss, lower transfusion rates, and shorter hospital stays. Intracorporeal neobladder reconstruction is an emerging technique that offers several benefits over extracorporeal reconstruction, including a reduction in the number of incisions and a shorter time to recovery. The Ves.Pa. refinement technique is a modification of the original approach that simplifies the procedure and reduces the risk of complications.

Objective: To report the Ideal stage 2a for RARC with intracorporeal neobladder reconstruction according to the Ves.Pa. refinement technique. Design, Setting, and Participants: consecutive patients prospectively treated by a single surgeon with RARC and Ves.Pa. for muscle-invasive or non-muscle invasive, BCG refractory urothelial bladder cancer in a tertiary referral center. Surgical Procedure: The Ves.Pa. technique involves intracorporeal suturing of the ureters, bladder neck, and neobladder without the use of a stapler. The technique also avoids the use of a funnel configuration of the bladder neck and ensures that the ureters are reimplanted on their respective sides.
Measurements: The study assessed the feasibility, safety, and oncological and functional outcomes of RARC with Ves.Pa. neobladder. Complications were classified using the Clavien-Dindo classification system, and functional outcomes were assessed using validated questionnaires.

Results and Limitations: A total of 21 patients underwent RARC with Ves.Pa. refinement technique for a totally intracorporeal neobladder. The median operative time was 375 minutes, and the median estimated blood loss was 400 ml. The prevalence of high-grade complications was extremely low, with only one patient experiencing a Clavien-Dindo grade IIIa complication. All patients had clear surgical margins. At the median follow-up of 12 months, patients had a median AUA-SI score of 8 and no one required intermittent catheterization. Urinary incontinence (ICIQ-UI) was reported moderate and severe in respectively 10 (48%) and 7 (33%). Only 19% did not wear pads at night. Of the male patients, median IIEF-5 score was 16 (IQR 12- 19) at available follow up. The study is limited by its small sample size, single-center design, and short follow-up duration.

Conclusions: The RARC with a Ves.Pa. refinement technique for a totally intracorporeal neobladder reconstruction is safe, feasible and replicable. The technique simplifies the procedure and reduces the risk of complications. The study’s results suggest acceptable oncological and functional outcomes at the available follow-up.

Patient Summary: We report our initial experience with robot-assisted radical cystectomy with intracorporeal neobladder reconstruction according to the Ves.Pa. technique. Our technique simplifies the procedure and reduces the risk of complications. We experienced an extremely low prevalence of high-grade complications, clear surgical margins in all cases, and fair functional outcomes at the available follow-up.

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