The learning curve for intra-corporal ileal conduit reconstruction in robotic assisted radical cystectomy: How steep does it go?
BAUS ePoster online library. Hannah M. 06/22/21; 319007; p10-18
Disclosure(s): I have no such affiliations.
Mr. Magnus Hannah
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Abstract
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Introduction.
Robotic assisted radical cystectomy (RARC) is being gradually adopted as the preferred surgical approach for radical cystectomy. Intra-corporal conduit re-construction (ICCR) presents challenges even in experienced hands. We document our experience and learning curve by studying the incidence of uretero-enteric stricture (UES) rates.
Patients and Methods.
Retrospective analysis of all (n=148) ICCR during RARC in our centre over 51 months by two surgeons experienced in open and robotic pelvic surgery. UES was identified by delayed excretion on CT Urography. Multiple operating and patient factors were studied. ICCR were sub-divided into cohorts of up to 50 patients in chronological order of operation date.
Results.
In 148 patients, 52 underwent Wallace and 96 Bricker's anastomoses. UES rate was 18%, 16% and 8% in the respective cohorts. Of patients with EUS, 52% had isolated left side and 9.5% right, with 38% bilateral. Median time to stricture diagnosis was 196, 97 and 131 days in the 3 cohorts (overall 140 days). Overall UES rate was 10% at 6 months and 14% at 12 months. 25% of patients with Wallace and 8% with Bricker's technique developed UES. Wallace was primarily utilised in earlier cases.
Other potential identified factors include neoadjuvant chemotherapy (18%), prior pelvic surgery (27.7%) and radiotherapy (33%) however numbers are small.
Conclusions.
ICCR after RARC requires significant technical expertise with a steep learning curve of at least 50 cases to decrease the UES rates to 8%. Bricker technique was noted to have a significantly lower rate of UES in our experience.
Robotic assisted radical cystectomy (RARC) is being gradually adopted as the preferred surgical approach for radical cystectomy. Intra-corporal conduit re-construction (ICCR) presents challenges even in experienced hands. We document our experience and learning curve by studying the incidence of uretero-enteric stricture (UES) rates.
Patients and Methods.
Retrospective analysis of all (n=148) ICCR during RARC in our centre over 51 months by two surgeons experienced in open and robotic pelvic surgery. UES was identified by delayed excretion on CT Urography. Multiple operating and patient factors were studied. ICCR were sub-divided into cohorts of up to 50 patients in chronological order of operation date.
Results.
In 148 patients, 52 underwent Wallace and 96 Bricker's anastomoses. UES rate was 18%, 16% and 8% in the respective cohorts. Of patients with EUS, 52% had isolated left side and 9.5% right, with 38% bilateral. Median time to stricture diagnosis was 196, 97 and 131 days in the 3 cohorts (overall 140 days). Overall UES rate was 10% at 6 months and 14% at 12 months. 25% of patients with Wallace and 8% with Bricker's technique developed UES. Wallace was primarily utilised in earlier cases.
Other potential identified factors include neoadjuvant chemotherapy (18%), prior pelvic surgery (27.7%) and radiotherapy (33%) however numbers are small.
Conclusions.
ICCR after RARC requires significant technical expertise with a steep learning curve of at least 50 cases to decrease the UES rates to 8%. Bricker technique was noted to have a significantly lower rate of UES in our experience.
Introduction.
Robotic assisted radical cystectomy (RARC) is being gradually adopted as the preferred surgical approach for radical cystectomy. Intra-corporal conduit re-construction (ICCR) presents challenges even in experienced hands. We document our experience and learning curve by studying the incidence of uretero-enteric stricture (UES) rates.
Patients and Methods.
Retrospective analysis of all (n=148) ICCR during RARC in our centre over 51 months by two surgeons experienced in open and robotic pelvic surgery. UES was identified by delayed excretion on CT Urography. Multiple operating and patient factors were studied. ICCR were sub-divided into cohorts of up to 50 patients in chronological order of operation date.
Results.
In 148 patients, 52 underwent Wallace and 96 Bricker's anastomoses. UES rate was 18%, 16% and 8% in the respective cohorts. Of patients with EUS, 52% had isolated left side and 9.5% right, with 38% bilateral. Median time to stricture diagnosis was 196, 97 and 131 days in the 3 cohorts (overall 140 days). Overall UES rate was 10% at 6 months and 14% at 12 months. 25% of patients with Wallace and 8% with Bricker's technique developed UES. Wallace was primarily utilised in earlier cases.
Other potential identified factors include neoadjuvant chemotherapy (18%), prior pelvic surgery (27.7%) and radiotherapy (33%) however numbers are small.
Conclusions.
ICCR after RARC requires significant technical expertise with a steep learning curve of at least 50 cases to decrease the UES rates to 8%. Bricker technique was noted to have a significantly lower rate of UES in our experience.
Robotic assisted radical cystectomy (RARC) is being gradually adopted as the preferred surgical approach for radical cystectomy. Intra-corporal conduit re-construction (ICCR) presents challenges even in experienced hands. We document our experience and learning curve by studying the incidence of uretero-enteric stricture (UES) rates.
Patients and Methods.
Retrospective analysis of all (n=148) ICCR during RARC in our centre over 51 months by two surgeons experienced in open and robotic pelvic surgery. UES was identified by delayed excretion on CT Urography. Multiple operating and patient factors were studied. ICCR were sub-divided into cohorts of up to 50 patients in chronological order of operation date.
Results.
In 148 patients, 52 underwent Wallace and 96 Bricker's anastomoses. UES rate was 18%, 16% and 8% in the respective cohorts. Of patients with EUS, 52% had isolated left side and 9.5% right, with 38% bilateral. Median time to stricture diagnosis was 196, 97 and 131 days in the 3 cohorts (overall 140 days). Overall UES rate was 10% at 6 months and 14% at 12 months. 25% of patients with Wallace and 8% with Bricker's technique developed UES. Wallace was primarily utilised in earlier cases.
Other potential identified factors include neoadjuvant chemotherapy (18%), prior pelvic surgery (27.7%) and radiotherapy (33%) however numbers are small.
Conclusions.
ICCR after RARC requires significant technical expertise with a steep learning curve of at least 50 cases to decrease the UES rates to 8%. Bricker technique was noted to have a significantly lower rate of UES in our experience.
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