Preliminary experience of female totally robot assisted radical cystectomy with the genital sparing and intracorporeal orthotopic ileal neobladder
Objective:To explore the feasibility of robot assisted radical cystectomy(RARC)with genital spar-ing combined with intracorporeal orthotopic neobladder(ONB)in female bladder cancer patients,combined with specimen retrieval via natural orifice,and to summarize the clinical experience and techniques.Methods:Clinical data of 8 female bladder cancer patients admitted to our department from July 2021 to May 2023 were retrospec-tively analyzed.The patients'ages ranged from 53 to 73 years,with a mean age of 63.3 years.The body mass in-dex(BMI)ranged from 17.3 to 27.9 kg/m2,with a mean of 23.1 kg/m2.The American Society of Anesthesiolo-gists(ASA)scores ranged from 1 to 3,with a mean of 2.All patients underwent RARC with genital sparing plus intracorporeal ileal neobladder reconstruction,and specimen retrieval via the vagina.Enhanced recovery after sur-gery(ERAS)was employed postoperatively,and patients were followed up for oncological and urinary functional status starting from 3 months postoperatively.Results:All operation were performed successfully.The mean op-erative time was 344.8 minutes(range:265-451 minutes),with estimated blood loss ranging from 150 to 500 mL(mean:281.3 mL).The mean length of hospital stay was 16.9 days(range:14-25 days).One patient developed an ileal neobladder fistula on postoperative day 7,which was managed conservatively,and she was dis-charged after 25 days.Another patient developed a pelvic lymphocele(diameter approximately 14 cm)around 1 month postoperatively,which was managed with CT-guided drainage.Postoperative urodynamic studies conducted around 3 months postoperatively showed a mean neobladder capacity of 249.1 mL(range:195.8-369.0 mL)and a mean residual urine volume of 24.4 mL(range:0-60 mL),with no patients requiring intermittent clean cathe-terization.Urinary incontinence assessment revealed that 87.5％,12.5％,and 0 of patients were rated as good,satisfactory,and unsatisfactory during the daytime,respectively,while 62.5％,25％,and 12.5％were rated as good,satisfactory,and unsatisfactory during the night,respectively.The median follow-up period was 16.8 months(range:10-33 months),and no tumor recurrence or metastasis observed.Conclusion:RARC with geni-tal sparing and intracorporeal ileal neobladder reconstruction in female bladder cancer patients,combined with specimen retrieval via natural orifice,is clinically safe and feasible.Compared to conventional radical cystectomy(RC)with ONB reconstruction,it may offer better urinary function.
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