Category: Laparoscopic/ Robotic: Other

MP30-3 - Outcomes and Learning-curve of Totally Intracorporeal Ileal Conduit Urinary Diversion following Laparoscopic Radical Cystectomy at Single-institution

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

Introduction & Objective :

In recent years, Robot-assisted and laparoscopic radical cystectomy (LRC) with intracorporeal ileal conduit (ICIC) has been increased in many high-volume centers. However, whether LRC with ICIC should be promoted is still controversial. Therefore, we describe our experience of laparoscopic radical cystectomy with ICIC compared with extracorporeal ileal conduit (ECIC).


Methods :

From June 2012 to February 2018, a total of 38 patients with bladder cancer underwent LRC with ileal conduit at our institution, of whom initial 8 patients underwent LRC with ECIC and latter 30 patients underwent LRC with ICIC. Treatment outcomes including surgical outcomes between ICIC (n=30) and ECIC (n=8) were compared. We also assessed learning curve during ICIC as to operating time and complication rate.


Results :

There were no significant differences in patient characteristics, median total operative time (516 min vs 627 min), median urinary diversion time (213 min vs 192 min) and median estimated blood loss (450 ml vs 420 ml) between the ICIC and ECIC groups. Median time to walk (2 vs 2 days) and oral intake (2 vs 2 days) were similar in both groups. The incidence of high grade complication associated with urinary diversion (Clavien-Dindo Grade≧Ⅲ) were 3% in ICIC and 25% in ECIC. Importantly, although 25% patients experienced wound dehiscence (Clavien-Dindo GradeⅢb) in ECIC group, there was no patient with post-operative wound infection in ICIC group. Moreover, patients with ICIC had lower incidence of severe ileus than with ECIC (3% vs 13%). As for learning curve of ICIC (n=30), urinary diversion time (27 min decrease per 10 cases, p=0.02), and total blood loss (179ml decrease per 10 cases, p=0.03) significantly decreased. The incidence and severity of complications also decreased with time.


Conclusions :

These results indicate that LRC with ICIC could be performed safely with low incidence of severe wound infection and ileus compared to ECIC. Operation time and complications of ICIC could be greatly improved with time.

Masashi Kubota

Assistant manager
Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Shiori Murata

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Noriyuki Makita

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Issei Suzuki

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Yoichiro Tohi

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Yoshio Sugino

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Koji Inoue

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan

Mutsushi Kawakita

Department of Urology, Kobe City Medical Centre General Hospital
Kobe, Hyogo, Japan