Refinement Surgical Technique, and Perioperative and Functional Outcomes in Patients with Robotic Intracorporeal Hautmann Orthotopic Neobladder

Abstract Objective To illustrate our refinement technique for robotic intracorporeal orthotopic Hautmann neobladder with adherence to open surgical principles and evaluate perioperative and functional outcomes. Patients and Methods Robot-assisted radical cystectomy (RARC) with intracorporeal Hautmann orthotopic neobladder was performed by the same surgeon in 40 patients with bladder cancer from November 2017 to March 2019. Baseline demographics, pathological data, 90-d complications, and functional outcomes at both 6 and 12 months were evaluated with questionnaire and urodynamic analysis. Results Median followup was 14 months (range 4 to 20). Median operative time was 320 (230–500) min, and the estimated blood loss was 300 (100-2000) ml. No conversion to the open technique was reported. The overall 90-d complication rate was 45%, and the high-grade complication rate was only 10%. The daytime satisfactory continence rate was 90% at both 6 months (30 patients) and 12 months (20 patients), while the night-time satisfactory continence rate was 76.7% and 80.0% at 6 months and 12 months, respectively. One patient underwent clean intermittent catheterization. The cohort had minimal postvoid residual volume, normal compliance, and a mean capacity of 328.7 cm3 (range 170–500) at 6 months postoperatively. Conclusion Our preliminary data indicate that robotic intracorporeal Hautmann neobladder configuration is a feasible surgical technique and can achieve a low pressure and sufficient capacity for satisfactory early voiding patterns. Refinement of the stepwise process can effectively decrease the time of the operation. Long-term functional and oncological outcomes remain to be evaluated with longer follow-up and more cases.