Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group
Background and objective: The use of robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has increased rapidly in the past decade. The approximation of the ileum toward the urethral stump could be a demanding step. Whereas the techniques for reconstruction have been desc...
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2025-06-01
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| author | Maria Chiara Sighinolfi Simone Assumma Peter Wiklund Richard Gaston Andrea Minervini Alex Mottrie Reza Mehrazin Abdullah Erdem Canda Enrico Panio Filippo Gavi Luca Sarchi Tommaso Calcagnile Filippo Turri Fabrizio Di Maida Luca Lambertini Hubert Jhon Rafael Coelho Abolfazi Hosseini Kris Maes Anup Kumar Sudhir Kumar Rawal T.B. Yuvaraja Giovanni Enrico Cacciamani Antonio Celia Costantino Leonardo Francesco Greco Roberto Falabella Filippo Annino Antonio Galfano Angelo Porreca Alessandro Crestani Paolo Umari Riccardo Bertolo Alessandro Antonelli Rocco Papalia Ugo Falagario Riccardo Schiavina John Sfakianos Neerja Tillu Carl Wijburg Vincenzo Tondolo Sergio Alfieri Alberto Breda Giorgia Gaia Stefano Terzoni Marcio Covas Moschovas Vipul Patel Bernardo Rocco |
| author_facet | Maria Chiara Sighinolfi Simone Assumma Peter Wiklund Richard Gaston Andrea Minervini Alex Mottrie Reza Mehrazin Abdullah Erdem Canda Enrico Panio Filippo Gavi Luca Sarchi Tommaso Calcagnile Filippo Turri Fabrizio Di Maida Luca Lambertini Hubert Jhon Rafael Coelho Abolfazi Hosseini Kris Maes Anup Kumar Sudhir Kumar Rawal T.B. Yuvaraja Giovanni Enrico Cacciamani Antonio Celia Costantino Leonardo Francesco Greco Roberto Falabella Filippo Annino Antonio Galfano Angelo Porreca Alessandro Crestani Paolo Umari Riccardo Bertolo Alessandro Antonelli Rocco Papalia Ugo Falagario Riccardo Schiavina John Sfakianos Neerja Tillu Carl Wijburg Vincenzo Tondolo Sergio Alfieri Alberto Breda Giorgia Gaia Stefano Terzoni Marcio Covas Moschovas Vipul Patel Bernardo Rocco |
| author_sort | Maria Chiara Sighinolfi |
| collection | DOAJ |
| description | Background and objective: The use of robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has increased rapidly in the past decade. The approximation of the ileum toward the urethral stump could be a demanding step. Whereas the techniques for reconstruction have been described in detail, a comprehensive depiction of strategies to facilitate neobladder-urethral approximation is lacking. This manuscript and video collection provide a summary of the techniques and maneuvers suggested by RARC surgeons. Methods and surgical procedure: This is a cross-sectional study in collaboration with the European Association of Urology Robotic Urology Section (ERUS) Scientific Working Group that evaluates strategies for ileourethral approximation and anastomosis from surgeons performing RARC with an intracorporeal neobladder. To this purpose, a survey was developed by a single institution with input from experts. The survey included questions on caseload, types of diversions, ileal approximation, and techniques and strategies for overcoming challenges in an ileourethral anastomosis. Responders were recruited among experts from scientific societies and were asked to rate the importance of these tricks on a Likert scale. A video collection was developed thereafter. Key findings and limitations: Twenty-one surgeons were involved, with five of them having an individual caseload of >300 cases. The Studer (n = 9) and Bordeaux (n = 9) reconstructions were most used; four operators declared the use of more than one type of diversion. Ileourethral approximation is considered a demanding part of intracorporeal neobladder reconstruction for 86% of participant surgeons. It is perceived as difficult in approximately one out of four surgical cases. Ten surgeons reported at least one conversion to ileal conduit due to impossible ileal descent. The posterior reconstruction was ranked as a useful trick to aid in an ileourethral anastomosis for ten surgeons (48%); a reduction in the Trendelenburg position by nine (43%), the use of small incisions in the mesentery was useful for six (29%) and opening the ileal segment before the anastomosis for five (24%) surgeons. Conclusions: Some strategies and techniques are available to facilitate ileal descent toward the pelvis to achieve a tension-free ileourethral anastomosis. The knowledge and application of these tricks are important to cope with this demanding step and make intracorporeal neobladder reconstruction easier and safer. Patient summary: The robotic realization of a neobladder through an intracorporeal approach could be demanding. The associated video presents some surgical strategies to make this step easier and safer, to ensure the achievement of a tension-free neobladder-urethral anastomosis. |
| format | Article |
| id | doaj-art-45638a4b4f3147c38d46e93b54677fce |
| institution | OA Journals |
| issn | 2666-1683 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj-art-45638a4b4f3147c38d46e93b54677fce2025-08-20T02:06:27ZengElsevierEuropean Urology Open Science2666-16832025-06-0176455010.1016/j.euros.2025.03.018Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working GroupMaria Chiara Sighinolfi0Simone Assumma1Peter Wiklund2Richard Gaston3Andrea Minervini4Alex Mottrie5Reza Mehrazin6Abdullah Erdem Canda7Enrico Panio8Filippo Gavi9Luca Sarchi10Tommaso Calcagnile11Filippo Turri12Fabrizio Di Maida13Luca Lambertini14Hubert Jhon15Rafael Coelho16Abolfazi Hosseini17Kris Maes18Anup Kumar19Sudhir Kumar Rawal20T.B. Yuvaraja21Giovanni Enrico Cacciamani22Antonio Celia23Costantino Leonardo24Francesco Greco25Roberto Falabella26Filippo Annino27Antonio Galfano28Angelo Porreca29Alessandro Crestani30Paolo Umari31Riccardo Bertolo32Alessandro Antonelli33Rocco Papalia34Ugo Falagario35Riccardo Schiavina36John Sfakianos37Neerja Tillu38Carl Wijburg39Vincenzo Tondolo40Sergio Alfieri41Alberto Breda42Giorgia Gaia43Stefano Terzoni44Marcio Covas Moschovas45Vipul Patel46Bernardo Rocco47Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy; Corresponding author. Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy. Tel. +39 3349383894.Fondazione Policlinico A. Gemelli IRCSS, Rome, ItalyThe Mount Sinai Hospital, New York, NY, USAUniversità degli Studi di Firenze, Florence, Italy; Hospital Saint Augustin, Bordeaux, FranceUniversità degli Studi di Firenze, Florence, ItalyOLV Hospital, Aalst, BelgiumThe Mount Sinai Hospital, New York, NY, USAKoç University, Istanbul, TurkeyFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyASST Santi Paolo e Carlo, Milan, ItalyASST Lariana, Como, ItalyFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyUniversità degli Studi di Firenze, Florence, ItalyUniversità degli Studi di Firenze, Florence, ItalyKSW Kantonsspital Winterthur, Winterthur, SwitzerlandHospital Sírio-Libanês, Sao Paulo, BrazilKarolinska Institutet, Stockholm, SwedenHospital da Luz, Lisbon, PortugalVardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaRajiv Gandhi Cancer Institute and Research Centre, New Delhi, IndiaKokilaben Dhirubhai Ambani Hospital, Mumbai, IndiaUniversity of Southern California, Los Angeles, CA, USAOspedale San Bassiano, Bassano del Grappa, ItalyUniversità degli Studi di Roma La Sapienza, Rome, ItalyPoliclinico San Pietro, Ponte San Pietro, ItalyAzienda Ospedaliera Regionale San Carlo, Potenza, ItalyOspedale San Donato, Arezzo, ItalyASST Grande Ospedale Metropolitano Niguarda, Milan, ItalyIstituto Oncologico Veneto IRCCS, Padova, ItalyOspedale Santa Maria della Misericordia, Perugia, ItalySt George’s University Hospitals NHS Foundation Trust, London, UKUniversità degli Studi di Verona, Verona, ItalyUniversità degli Studi di Verona, Verona, ItalyUniversità Campus Bio-Medico di Roma, Rome, ItalyUniversità degli Studi di Foggia, Foggia, ItalyUniversità degli Studi di Bologna, Bologna, ItalyThe Mount Sinai Hospital, New York, NY, USAThe Mount Sinai Hospital, New York, NY, USARijnstate Hospital, Arnhem, The NetherlandsFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyFundació Puigvert, Barcelona, SpainFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyASST Grande Ospedale Metropolitano Niguarda, Milan, ItalyAdventHealt Global Robotic Institute, Celebration, USAAdventHealt Global Robotic Institute, Celebration, USAFondazione Policlinico A. Gemelli IRCSS, Rome, ItalyBackground and objective: The use of robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has increased rapidly in the past decade. The approximation of the ileum toward the urethral stump could be a demanding step. Whereas the techniques for reconstruction have been described in detail, a comprehensive depiction of strategies to facilitate neobladder-urethral approximation is lacking. This manuscript and video collection provide a summary of the techniques and maneuvers suggested by RARC surgeons. Methods and surgical procedure: This is a cross-sectional study in collaboration with the European Association of Urology Robotic Urology Section (ERUS) Scientific Working Group that evaluates strategies for ileourethral approximation and anastomosis from surgeons performing RARC with an intracorporeal neobladder. To this purpose, a survey was developed by a single institution with input from experts. The survey included questions on caseload, types of diversions, ileal approximation, and techniques and strategies for overcoming challenges in an ileourethral anastomosis. Responders were recruited among experts from scientific societies and were asked to rate the importance of these tricks on a Likert scale. A video collection was developed thereafter. Key findings and limitations: Twenty-one surgeons were involved, with five of them having an individual caseload of >300 cases. The Studer (n = 9) and Bordeaux (n = 9) reconstructions were most used; four operators declared the use of more than one type of diversion. Ileourethral approximation is considered a demanding part of intracorporeal neobladder reconstruction for 86% of participant surgeons. It is perceived as difficult in approximately one out of four surgical cases. Ten surgeons reported at least one conversion to ileal conduit due to impossible ileal descent. The posterior reconstruction was ranked as a useful trick to aid in an ileourethral anastomosis for ten surgeons (48%); a reduction in the Trendelenburg position by nine (43%), the use of small incisions in the mesentery was useful for six (29%) and opening the ileal segment before the anastomosis for five (24%) surgeons. Conclusions: Some strategies and techniques are available to facilitate ileal descent toward the pelvis to achieve a tension-free ileourethral anastomosis. The knowledge and application of these tricks are important to cope with this demanding step and make intracorporeal neobladder reconstruction easier and safer. Patient summary: The robotic realization of a neobladder through an intracorporeal approach could be demanding. The associated video presents some surgical strategies to make this step easier and safer, to ensure the achievement of a tension-free neobladder-urethral anastomosis.http://www.sciencedirect.com/science/article/pii/S2666168325001053Bladder cancerRobotic cystectomyIntracorporeal neobladderBowelAnastomosisSurgical technique |
| spellingShingle | Maria Chiara Sighinolfi Simone Assumma Peter Wiklund Richard Gaston Andrea Minervini Alex Mottrie Reza Mehrazin Abdullah Erdem Canda Enrico Panio Filippo Gavi Luca Sarchi Tommaso Calcagnile Filippo Turri Fabrizio Di Maida Luca Lambertini Hubert Jhon Rafael Coelho Abolfazi Hosseini Kris Maes Anup Kumar Sudhir Kumar Rawal T.B. Yuvaraja Giovanni Enrico Cacciamani Antonio Celia Costantino Leonardo Francesco Greco Roberto Falabella Filippo Annino Antonio Galfano Angelo Porreca Alessandro Crestani Paolo Umari Riccardo Bertolo Alessandro Antonelli Rocco Papalia Ugo Falagario Riccardo Schiavina John Sfakianos Neerja Tillu Carl Wijburg Vincenzo Tondolo Sergio Alfieri Alberto Breda Giorgia Gaia Stefano Terzoni Marcio Covas Moschovas Vipul Patel Bernardo Rocco Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group European Urology Open Science Bladder cancer Robotic cystectomy Intracorporeal neobladder Bowel Anastomosis Surgical technique |
| title | Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group |
| title_full | Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group |
| title_fullStr | Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group |
| title_full_unstemmed | Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group |
| title_short | Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group |
| title_sort | strategies and techniques for ileourethral approximation during robotic intracorporeal neobladder reconstruction an international survey and video collection in collaboration with the european association of urology robotic urology section scientific working group |
| topic | Bladder cancer Robotic cystectomy Intracorporeal neobladder Bowel Anastomosis Surgical technique |
| url | http://www.sciencedirect.com/science/article/pii/S2666168325001053 |
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