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Page 12 of 19 Maqboul et al. Mini-invasive Surg 2021;5:44 https://dx.doi.org/10.20517/2574-1225.2021.54

Table 4. Robotic intracorporeal neobladder study series: result of pooled data analysis for all outcomes
Outcome Median/Rate (interquartile range/calculation)
Peri-operative outcome
Median OT (min) in RIN 435 (IQR = 57)
Median EBL (mL) in RIN 415 (IQR = 207.5)
Mean transfusion rate in RIN 8.73% (20/229)
Mean complication Clavien-Dindo ≥ III rate at 30 days in RIN 20.25% (99/489)
Mean complication Clavien-Dindo ≥ III rate at 90 days in RIN 13.39% (64/478)
Median length of hospital stay (days) in RIN 9 (IQR = 4.5)
Oncology outcome
Mean Post-operative organ confined disease (≤pT2) in RIN 80.04% (401/405)
Mean Positive surgical margins in RIN 1.86% (9/485)
Median lymph node yield (number) 23 (IQR = 7.5)
Mean follow up (months) 27.43 (range: 13-37)
Calculated mean cancer survival rate CSR% 77.96% (375/481)
Estimated median disease survival rate DSR% 78.35% (IQR = 13)
Estimated median overall survival rate OSR% 72% (IQR = 23.4)
Functional outcome (studies with follow up at least for 6 months)
Mean daytime continence rate 81.52% (225/276)
Mean nighttime continence rate 61.08% (124/203)
Mean spontaneous sexual activity/potency rate 33.51% (64/191)

IQR: Interquartile range; RIN: robotic intracorporeal neobladder; OT: operating time; EBL: estimated blood loss.

from the obvious functional advantages, there is also the potential for less bowel manipulation, less blood
and fluid loss, less hypothermia, and reduced ureteric trauma leading to lower ureteric stricture rates [1,10,11] .
Although a small proportion of patients in the reviewed series underwent intracorporeal ileal conduits, the
overwhelming majority OF 87.5% had RARC with RIN.

Perioperative outcomes (see Table 1)
Less blood and fluid loss has been suggested as an advantage for ICUD. Prior figures from the recent IRCC
analysis of ICUD vs. ECUD, of which 21% vs. 23% were neobladders, found less estimated blood loss (EBL)
for ICUD at 300 mL vs. 350 mL and less transfusion at 5% vs. 13%. The median EBL of the series reviewed is
415 mL (IQR = 207.5), suggesting RIN may be associated with higher EBL compared to intracorporeal or
extracorporeal ileal conduit. Where assessed, the transfusion rates in the series reviewed varied significantly
from 4.2% to 66.7%, reflected in the variation in the numbers of patients and experience of the surgeons,
and on pooled analysis, the transfusion rate is at 8.7%. For the larger series from established centers,
[1]
transfusion rates for RIN (4.35% and 4.5%) are less than those quoted for ECUD in the IRCC data (13%) .
Long OTs have contributed to complication rates and, with prolonged Trendelenburg position, may give
rise to specific complications such as compartment syndrome or posterior infarction of the optic nerve. The
combined OT of extended lymph node dissection, with additional nerve-sparing in men, or pelvic organ
sparing in women will necessarily add to the duration of the procedure, sometimes breaching the
recommended OT of the Pasadena Consensus Panel (PCP) of < 7 h . Nevertheless, the larger series from
[12]
high-volume centers note a definite drop in OTs over the period of study, Hosseini et al. suggesting a
[5]
plateau of approximately 5 h after 80 cases. Tuderti et al. performing an Intracorporeal Padua Ileal
[13]
Neobladder with pelvic organ sparing RARC in women achieved a mean OT of 255 min. The median OT in
Table 1 is 435 min (IQR = 57), just over the 7 h recommended by the PCP. Once again, the emphasis is on
high volume centers with experienced surgical teams as well as standardization of the procedure to reduce
OTs. Ninety-days high-grade complications rate from this series is 13.39%, ranging from 6% to 26%. It