Abstract：Objective: To summarize the clinical operative technique and effect of totally robotic-assisted laparoscopic radical cystectomy (tRARC) with orthotopic ileal neobladder by da Vinci surgical system. Methods: From Mar 2012 to July 2015, 9 male patients of bladder urothelial carcinomas underwent tRARC with orthotopic ileal neobladder were enrolled. The mean age was 54 years (ranged from 37-64 years). All patients were diagnosed preoperatively with muscle-invasive or high-grade bladder urothelial carcinomas in cystoscopic biopsy. There were no adjacent organ infiltration found, pelvic lymph node metastases or distant metastasis on preoperative examinations, and the clinical stage were all below T3N0M0. General anesthesia was administered for tRARC with intracorporeal orthotopic ileal neobladder to all patients. Results: All 9 cases were successful. The average operation time was 520min (ranged from 360-780 min) with average blood loss of 555ml (300 to 1 200 ml), and the average number of lymph nodes was 13 (ranged from 4 to 23). All patients resumed ambulation on postoperative 2 to 3 days, and bowel function recovered on either postoperative day 3 or 4. The average length of hospital stay was 20d (ranged from 10-32 d). One month after operation a cystogram was performed to confirmed watertight healing. During the follow up of 3-43 months (mean 30 months ). All of the patients have normal renal functions and satisfactory urinary continence without hydronephrosis. Conclusions: According to the initial surgery procedure and the results of the initial operation, the tRARC with intracorporeal orthotopic ileal neobladder by da Vinci surgical system is feasible in clinic. More基金项目:国家高技术研究发展计划(863计划)(2012AA021100) operational experience, standard surgical procedures, long-term and randomized controlled studies will be helpful to evaluate and promote the technology.
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