Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.

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Faculty Opinions recommendation of Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733797405.793567279 ◽

2019 ◽

Author(s):

Moneer Hanna

Keyword(s):

Randomised Controlled Trial ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Feasibility Study ◽

Controlled Trial ◽

Robot Assisted ◽

Open Radical Cystectomy ◽

Randomised Controlled ◽

Intracorporeal Urinary Diversion

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Use of indocyanine green fluorescence imaging to determine the area of ileum with poor blood flow during robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

Journal of Clinical Urology ◽

10.1177/2051415820974274 ◽

2020 ◽

pp. 205141582097427

Author(s):

Shugo Yajima ◽

Yasukazu Nakanishi ◽

Shunya Matsumoto ◽

Kenji Tanabe ◽

Hitoshi Masuda

Keyword(s):

Blood Flow ◽

Indocyanine Green ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Near Infrared ◽

Infrared Imaging ◽

Da Vinci ◽

Robot Assisted ◽

Level Of Evidence ◽

Intracorporeal Urinary Diversion

Introduction: The utility of Firefly mode, a technology using near-infrared imaging, used with the intravenous injection of indocyanine green, and which is available as an optional feature for the Da Vinci surgical platform has recently been explored. We herein describe a case in which we detected the ileum with inadequate blood flow using Firefly mode during the processing of the robot-assisted radical cystectomy with intracorporeal urinary diversion. Presentation of the case: A 75-year-old woman diagnosed as having invasive bladder cancer underwent robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion using a Da Vinci Xi surgical system. We used Firefly mode after injection of indocyanine green during the processing of the intracorporeal digestive restoration, which resulted in providing intraoperative visual assessment of blood flow to the ileum, allowing us to detect intestine with inadequate blood flow which was not so obvious under the normal visible light mode. We resected the ileum with poor blood flow and reanastomosed the residual small bowel. The patient was released from the hospital only with minor complications. Conclusion: Firefly mode, used with indocyanine green has a potential to be a useful tool that may facilitate robotic surgery including robot-assisted radical cystectomy with intracorporeal urinary diversion. Level of evidence: 5 (case report)

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