Category: Robotic Surgery: New Techniques - Malignant

VS18-2 - Robotic assisted laparoscopic intracorporeal ileal conduit.Surgical technique & Single surgeon-single institute (90 days) outcomes.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

At present, robotic assisted laparoscopic intracorporeal ileal conduit is emerging as the preferred and challenging method of urinary diversion.
We share our technique and 90-days outcomes of Robotic assisted ileal conduit formation.

Methods :

Robotic assistance was used to form an intracorporeal ileal conduit after Radical cystoprostatectomy & ePLND in 145 cases of muscle invasive bladder cancers (2012-2018). The steps of technique include transposition of the left ureter, Isolation of ileal loops, Ileal segment division, ileo-ileal anastomosis, Ureteroenteric anastomosis (Bicker’s), Ureteric stenting and maturation of the ileal conduit and stoma.  The follow-up period was 90days.

Results :

Mean age 60 years (55-65) operating time was 140 minutes (range 120 to 160), blood loss 220 cc (range 200 to 250) and hospital stay 10 days. Clavien-Dindo Complications [Minor (Grade I & II) & Major (Grade III and above)] were 11% and 6% respectively upto 30days and 6% and 1% respectively between 30 - 90 days. Mean nodal yield was 24 (range 15to 30). Final diagnosis showed pT1-pT2 and pT3 – pT4 in 8% and 14% of specimens with a node positivity rate 7% and no positive surgical margins. During follow-up there was no tumor recurrence. To date, there have been no complications associated with the ileal conduit.

Conclusions : Robotic intracorporeal ileal conduit has good functional and oncological outcomes and appears to be a viable alternative to an open approach. Whilst being technically challenging, this procedure is safe, feasible, and reproducible. Patients who avoid complication show potential for rapid recovery and early discharge.

Santosh SUBHASH. Waigankar

Post Doctoral Fellow in Urooncology and Robotic Surgery
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India

Dr. Santosh Waigankar is a trained urologist from India who is presently pursuing urooncology and robotic surgery. After completing his training in urology, he decided to venture into subspecialty of urooncology and robotic surgery. He was selected as the first Vattikuti fellow in robotic urooncology in India (2015) and joined Kokilaben Dhirubhai Ambani hospital under the mentorship of Dr. T. B. Yuvaraja. He has been since associated with the department gaining valuable experience in Si and Xi DaVinci setups, as a beside and a console surgeon.

Fueled with curiosity and eagerness to learn he loves to interact with like-minded people across India and all over the world. He believes that gaining professional experience globally helps oneself to improve one’s perspective and broaden one’s approach to managing urological cancers.

He loves research and wants to work in areas as well looking into “unconventional” issues related to urological cancers as a whole e.g. molecular biology and ways to augment treatment outcomes in future. Doing research is his way of reciprocating back to the community.

His first international entry at the European Robotic Urology Society (ERUS 2017) won him the second prize for the best poster submission. The paper analyzed the “measured” outcomes post robotic partial nephrectomies. He has been awarded the scholarship for attending the 38th Société Internationale d'Urologie Congress (SIU 2018), scheduled to be held in Seoul.

He has keen interest in single port robotic surgery and aspires to get trained in the same.

He loves making friends from all walks of life and believes in knowledge sharing to enrich oneself. He is active on social media. He loves blogging and photography and follows cricket, tennis and F1 racing. Balancing between family, friends and professional life has been his priority always.

Srivathsan Ramani

Fellow - Robotic Urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Yuvaraja Tb

Head of robotic surgery and urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Abhinav Pednekar

Resident Surgical Oncology
Kokilaben Dhirubhai Ambani Hospital and Research Institute
Mumbai, Maharashtra, India