Open Access

ARTICLE

Intracorporeal urinary diversion during robot-assisted radical cystectomy using indocyanine green

Stefan Jeglinschi^1,2, Mathieu Carlier¹, Louis Denimal¹, Bertrand Guillonneau^3,4, Daniel Chevallier¹, Brannwel Tibi¹, Matthieu Durand¹, Youness Ahallal¹

1 Department of Urology, Pasteur University Hospital, Nice, France
2 Department of Urology, Grasse Hospital Center, Grasse, France
3 Department of Urology, Diaconesses-Croix St-Simon Hospital, Paris, France
4 Department of Urology, Charite University Hospital, Berlin, Germany
Address correspondence to Dr. Youness Ahallal , Department of Urology, Pasteur University Hospital, 30 Avenue Romaine, Nice 06001 France

Canadian Journal of Urology 2020, 27(5), 10394-10401.

Abstract

Introduction: To describe the feasibility of total intracorporeal urinary diversion during robotic assisted radical cystectomy using indocyanine green (ICG) and the Firefly system of the da Vinci Xi robot and to evaluate the digestive and urinary outcomes of this technique.
Materials and methods: After approval by the Institutional Review Board, we studied all consecutive patients who underwent robotic assisted radical cystectomy (RARC) and intracorporeal urinary derivation (ICUD) with the da Vinci Xi robot using ICG and the Firefly system, in our institution from January 1st, 2018 to September 15th, 2018. Pre, intra and postoperative data were analyzed with a follow up of at least 1 month.
Results: We included 25 patients. Preoperative data were the following: 92% were men, median age was 74 years (IQR 69-76), 64% of patients had an ASA score ≥ 3. Median operative time was 390 min (IQR 360-460). Median return to bowel function was 3 days for gas (IQR 2-5) and 5 days for stool (IQR 3-6). Median length of hospital stay was 8 days (IQR 7-10). After a median follow up of 9.6 months (IQR 8.3-12.5), only one patient (4%) presented with postoperative obstructive syndrome. There were 2 (8%) urinary leaks and 1 (4%) uretero-enteric stricture. There were no digestive fistulas recorded. Eleven patients (44%) were readmitted within 90 days for complications.
Conclusions: Total intracorporeal urinary diversion during robotic assisted radical cystectomy using ICG is a feasible technique that might reduce return of bowel function and has low urinary and digestive complications.

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