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Page 6 of 8 Tak et al. Mini-invasive Surg 2018;2:15 I http://dx.doi.org/10.20517/2574-1225.2018.05

Table 6. Final histopathology T stage and N stage of study population
Pathological stage Number of patients
T1 16
T2 46
T3 48
T4 6
N0 78
N1 35
N2 3
N3 0

technique of robotic-assisted laparoscopic radical cystectomy and neobladder construction or conduit
using a Pfannenstiel incision has been favorable. Pfannenstiel incision provides good exposure, facilitating
neobladder reconstruction, can be used for specimen retrieval, bowel anastomosis and heals better with a
cosmetic scar .
[4]

Manoharan et al. had conducted a similar study in 2011. He showed that, for those with pfannenstiel
[4]
incision the mean hemoglobin drop was 1.8 ± 1 g per deciliter, while in our study; group A Pfannenstiel
incision had 1.75 g per deciliter mean hemoglobin drop. Mean operating time was 6 ± 0.8 h in their study
while in our study the mean operative time for group A was 4.3 ± 1.1 h. According to what was reported
by Manoharan et al. , in our study there were no intra-operative visceral injuries in group A, but in group
[4]
B where midline incision was used, there was one case of rectal injury out of 63 patients (0.01%), which
was managed with a de-functioning colostomy. None of the patients reported by Manoharan et al. had positive
[4]
surgical margins similar to our study with either group. The mean number of lymph nodes removed was 12 ± 3
in their study, by contrast, in our study it was 22.27± 14.32 for group A having Pfannenstiel incision. The
mean hospital stay in their report was 8.5 days, but it was 10.16 ± 3.39 days in our study for group A having
Pfannenstiel incision.

Raychaudhuri et al. mentioned the work of Puppo, which was a series of laparoscopic RC with transvaginal
[2]
delivery of specimens. Mini-laparotomy incision was used for the ileal conduit in that series . The total operative
[2]
duration was 6-9 h (in our study it was 4.3-6.9 h) and the hospital stay 7-11 days, but it was 10.16 ± 3.39 days in
our study for group A having Pfannenstiel incision and for group B it was 13.63 ± 5.37 days.

Raychaudhuri et al. also mentioned the work of Denewer who reported a series of 10 laparoscopic salvage
[2]
(after radiotherapy) RC; this cohort of patients had ureterosigmoidostomy performed through a mini-
laparotomy . Complications (morbidity and mortality) in this study, were comparable with our study.
[2]
According to the data from an international registry on laparoscopic RC in 572 patients , the mean operating
[3]
time was 6.2 h with only 53% having open neo-bladder. Mean operative time for group A was 4.3 ± 1.1 h
and that of group B was 6.9 ± 3.0 h. Most of the midline incision cases were performed in our initial phase
of minimal access approach, so we took longer time though the reconstruction time was comparable. The
mean length of hospital stay as per that registry was 13 days (range 3-90 days) while in our study group
B had similar length of hospital stay (13.63 ± 5.37 days) but it was mere 10.16 ± 3.39 days for group A.
Intra-operative and postoperative complications occurred in 33 (7%) and 139 (28%) patients, respectively. In
our study, postoperative complications for group A occurred in 24% of patients compared to the results of
international registry; for group B complications occurred in 46% patients, this difference may be because
we were in an initial phase learning of minimal access approach .
[3]

In one recent series of robotic RC, the operating time was reported to be 6.1 h . With a majority of the patients
[3]
having ileal conduit, the operating time for orthotopic pouch would be much more than the reported mean