The patient-side surgeon plays a key role in facilitating robot-assisted intracorporeal ileal conduit urinary diversion in men

Abstract

The influence of the console surgeon on the feasibility and outcome of various robot-assisted surgeries has been evaluated. These variables may be partially affected by the skills of the patient-side surgeon (PSS), but this has not been evaluated using objective data. This study aimed to describe the surgical techniques of the PSS in robot-assisted radical cystectomy (RARC) and intracorporeal ileal conduit (ICIC) urinary diversion and objectively examine the changes in surgical outcomes with increasing PSS experience. During a 3-year period, 28 men underwent RARC and ICIC urinary diversion. Clinical characteristics and surgical outcomes were compared between patients who underwent surgery early (first half group) or late in the study period (second half group). The pre-docking incision enabled easy specimen removal. The glove port technique widened the working space of the PSS. The stay suture allowed the PSS to control the distal portion of the conduit, facilitating the passage of the ureteral stents. During stoma creation, pneumoperitoneum pressure was lost by opening the abdominal cavity. To overcome this problem, the robotic arm was used to lift the abdominal wall to maintain the surgical field and facilitate the PSS procedure. Compared with the first half group, the second half group had significantly shorter times for urinary diversion (202 min vs 148 min, p < 0.001), ileal isolation and anastomosis (73 min vs 45 min, p < 0.001), and stenting (23.0 min vs 6.5 min, p < 0.001). As the experience of the PSS increased, the time of the PSS procedures decreased.

Keywords: Minimally invasive surgery; Patient-side surgeon; Robot-assisted intracorporeal ileal conduit urinary diversion; Surgical technique.

Conflict of interest statement

Yutaro Sasaki, Masayuki Takahashi, Kyotaro Fukuta, Keito Shiozaki, Kei Daizumoto, Keisuke Ozaki, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi, Hirofumi Izaki, Kazuya Kanda and Hiroomi Kanayama declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1

The port locations

Fig. 2

A The glove port technique. B The patient-side surgeon (PSS) operates an automatic anastomosis device from the normal port. C The PSS operates an automatic anastomosis device from the glove port

Fig. 3

The schema of the passage of the ureteral stents using the laparoscopic suction tip and stay suture technique

Fig. 4

Despite the absence of pneumoperitoneal pressure, the surgical field can be secured by lifting the abdominal wall with the robot arm. The green gloved finger points to the stoma hole

Fig. 5

Learning curve