BACKGROUND: To report the perioperative and early functional outcomes of patients undergoing Robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion performed by a single surgeon after a modified modular training. METHODS: The surgeon (A.P.) attained a 30-days modified modular training at a referring Center mentored by a worldwide-recognized robotic surgeon (P.W.). The training program consisted of: 1) e-learning based on 10 hours of theoretical lessons made by the mentor; 2) video-session concerning the different steps of the procedure, 3) step-by-step in vivo modular training. Demographics, intraoperative data and post-operative complications were recorded for each patient. RESULTS: Twenty-four consecutive patients were prospectively evaluated. Median age was 68.5 years (IQR 59-75). Thirteen (54.2%) and 11 (45.8%) patients received RARC with orthotopic neobladder (ONB) and ileal conduit (IC), respectively. Overall mean (±SD) operative time was 392 (± 34.8) minutes. The median number of lymph node retrieved was 30 (IQR 24-42), the mean intraoperative estimated blood loss (EBL) was 403 mL (±60) with average hospitalization of 7.8 days (±2.2). All procedures were completed successfully without open conversion. A statistically significant difference in terms of overall operative time (OT) and urinary diversion operative time (UDOT) was found in favor of IC group compared to ONB group (P=0.002). Overall complication rate was 33%, 7 out of 9 (88%) were graded as minor (Clavien 1-2). Two (22%) major complications (Clavien 3-5) occurred solely on ONB group. CONCLUSIONS: Robot-assisted radical cystectomy with totally intracorporeal urinary diversion is a challenging procedure with a steep learning curve. An adequate modular training with an experienced mentor and a skilled robotic team could be essential to reach these optimal results. Further studies investigating the impact of modular learning curve and a dedicated menthorship on operative and functional outcomes after RARC are needed.
BACKGROUND: To report the perioperative and early functional outcomes of patients undergoing Robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion performed by a single surgeon after a modified modular training. METHODS: The surgeon (A.P.) attained a 30-days modified modular training at a referring Center mentored by a worldwide-recognized robotic surgeon (P.W.). The training program consisted of: 1) e-learning based on 10 hours of theoretical lessons made by the mentor; 2) video-session concerning the different steps of the procedure, 3) step-by-step in vivo modular training. Demographics, intraoperative data and post-operative complications were recorded for each patient. RESULTS: Twenty-four consecutive patients were prospectively evaluated. Median age was 68.5 years (IQR 59-75). Thirteen (54.2%) and 11 (45.8%) patients received RARC with orthotopic neobladder (ONB) and ileal conduit (IC), respectively. Overall mean (±SD) operative time was 392 (± 34.8) minutes. The median number of lymph node retrieved was 30 (IQR 24-42), the mean intraoperative estimated blood loss (EBL) was 403 mL (±60) with average hospitalization of 7.8 days (±2.2). All procedures were completed successfully without open conversion. A statistically significant difference in terms of overall operative time (OT) and urinary diversion operative time (UDOT) was found in favor of IC group compared to ONB group (P=0.002). Overall complication rate was 33%, 7 out of 9 (88%) were graded as minor (Clavien 1-2). Two (22%) major complications (Clavien 3-5) occurred solely on ONB group. CONCLUSIONS: Robot-assisted radical cystectomy with totally intracorporeal urinary diversion is a challenging procedure with a steep learning curve. An adequate modular training with an experienced mentor and a skilled robotic team could be essential to reach these optimal results. Further studies investigating the impact of modular learning curve and a dedicated menthorship on operative and functional outcomes after RARC are needed.
Authors: Karthik Tanneru; Seyed Behzad Jazayeri; Jatinder Kumar; Muhammad Umar Alam; Daniel Norez; Sabine Nguyen; Soroush Bazargani; Hariharan Palayapalayam Ganapathi; Mark Bandyk; Robert Marino; Shahriar Koochekpour; Shiva Gautam; K C Balaji; Joseph Costa Journal: J Robot Surg Date: 2020-11-22
Authors: Angelo Porreca; Katie Palmer; Walter Artibani; Alessandro Antonelli; Lorenzo Bianchi; Eugenio Brunocilla; Aldo Massimo Bocciardi; Maurizio Brausi; Gian Maria Busetto; Marco Carini; Giuseppe Carrieri; Antonio Celia; Luca Cindolo; Giovanni Cochetti; Renzo Colombo; Ettore De Berardinis; Ottavio De Cobelli; Fabrizio Di Maida; Amelio Ercolino; Franco Gaboardi; Antonio Galfano; Andrea Gallina; Michele Gallucci; Carlo Introini; Ettore Mearini; Andrea Minervini; Francesco Montorsi; Gennaro Musi; Giovannalberto Pini; Riccardo Schiavina; Silvia Secco; Sergio Serni; Claudio Simeone; Giovanni Tasso; Daniele D'Agostino Journal: BMC Cancer Date: 2021-01-11 Impact factor: 4.430
Authors: Angelo Porreca; Luca Di Gianfrancesco; Walter Artibani; Gian Maria Busetto; Giuseppe Carrieri; Alessandro Antonelli; Lorenzo Bianchi; Eugenio Brunocilla; Aldo Massimo Bocciardi; Marco Carini; Antonio Celia; Giovanni Cochetti; Andrea Gallina; Ettore Mearini; Andrea Minervini; Riccardo Schiavina; Sergio Serni; Daniele D'Agostino; Erica Debbi; Paolo Corsi; Alessandro Crestani Journal: Cent European J Urol Date: 2022-05-04