Robotic Intracorporeal Ileal Conduit Formation: Initial Experience from a Single UK Centre

Objectives. To describe our technique of robotic intracorporeal ileal conduit formation (RICIC) during robotic-assisted radical cystectomy (RARC). To report our initial results of this new procedure. Patients and Methods. Seven male and one female patients underwent RARC with RICIC over a six-month period. Demographic, operative, and outcome data was collected prospectively. Median patient age was 75 years (range 62–78 years). Median followup was 9 months (range 7–14 months). Results. RARC with RICIC was performed successfully in all eight patients. The median total operating time was 360 minutes (range 310–440 minutes) with a median blood loss of 225？mL (range 50–1000？mL). The median length of stay was nine days (range 6–34 days). Four patients (50%) were discharged within seven days. Four patients (50%) experienced one or more complications. This included two Clavien I complications, two Clavien II complications, and two Clavien III complications. Two patients (25%) required transfusion of two units each. To date, there have been no complications associated with the ileal conduit. Conclusion. Whilst being technically challenging, this procedure is safe, feasible, and reproducible. Patients who avoid complication show potential for rapid recovery and early discharge. 1. Introduction Advances in robotic surgery over the last decade have led to increasingly more complex procedures being undertaken. Robotic-assisted radical cystectomy (RARC) with extracorporeal diversion has become an established alternative to open radical cystectomy (ORC) in many specialist centres worldwide [1–6]. More recently, we have seen the evolution of robotic intracorporeal ileal conduit (RICIC) formation, although this is still relatively in its infancy and is limited to a handful of centres [7–10]. To the best of our knowledge, at the time of writing there are only four surgeons at four separate institutions performing RICIC in the United Kingdom. This is the first report of RICIC results in the UK. Our robotic surgery program at the Hertfordshire and South Bedfordshire Urological Cancer Centre began in 2008, beginning with robotic-assisted radical prostatectomy (RARP). RARC was introduced in 2010 and our first RARC with RICIC was performed in January 2012. In this paper, we describe our technique of RICIC and report our initial results. 2. Patients and Methods Patient selection for RARC with RICIC followed our same guidelines for RARC with extracorporeal diversion. In general, we avoid patients with previous major abdominal surgery as for any procedure requiring