PMID- 29140596
OWN - NLM
STAT- MEDLINE
DCOM- 20180313
LR  - 20221207
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 121
IP  - 2
DP  - 2018 Feb
TI  - Florence robotic intracorporeal neobladder (FloRIN): a new reconfiguration 
      strategy developed following the IDEAL guidelines.
PG  - 313-317
LID - 10.1111/bju.14077 [doi]
AB  - OBJECTIVE: To describe our step-by-step technique for robotic intracorporeal 
      neobladder configuration, including the stages of conception, development and 
      exploration of this surgical innovation, according to the Idea, Development, 
      Exploration, Assessment, Long-term follow-up (IDEAL) Collaboration guidelines. 
      PATIENTS AND METHODS: The Florence robotic intracorporeal neobladder (FloRIN) was 
      performed employing the following main surgical steps: isolation of 50 cm of 
      ileum; bowel anastomosis; urethro-ileal anastomosis creating an asymmetrical 
      'U'-shape (30 cm distally and 20 cm proximally to anastomosis), ileum 
      detubularisation; posterior wall reconfiguration as an 'L'; bladder neck 
      reconstruction; anterior folding of the posterior plate to reach the 12 o'clock 
      position; uretero-enteral 'orthotopic' bilateral anastomosis. The conception and 
      development of the FloRIN followed the IDEAL guidelines recommended stages: Phase 
      1 (simulation) involved the neobladder robotic configuration using silicone 
      models. Phase 2a (development) aimed to reproduce the configuration in an open 
      fashion in one patient, and then in the first three robotic procedures. Phase 2b 
      (exploration) consisted of the technique standardisation in 15 consecutive 
      robotic approaches. Phase 2a and 2b included urodynamics and imaging assessment 
      of the patients treated. RESULTS: From February 2016 to September 2017 FloRIN was 
      performed in 18 patients. Comparing the first three (Phase 2a) with the 
      subsequent 15 patients (Phase 2b), the median (interquartile range [IQR]) 
      reconstruction operating time was 260 (220-340) vs 160 (150-210) min, 
      respectively. Postoperative surgical complications occurred in four of the 18 
      patients (22.1%), including one surgical Clavien-Dindo Grade III and three Grade 
      I, postoperative medical Clavien-Dindo Grade II complications occurred in three 
      (16.7%) patients. On urodynamic examination (available in nine [50%] patients) 
      the median (IQR) reservoir cystometric capacity, compliance, and post-void 
      residual were 240 (220-267) mL, 18 (12.5-19.8) mL/cmH(2) O, and 0 (0-50) mL, 
      respectively. Ultrasonography showed no Grade >/=2 vesico-ureteric reflux. 
      CONCLUSION: We describe the FloRIN configuration, showing its technical 
      feasibility with acceptable time efficiency. The first cases studied had good 
      reservoir capacity, low pressure with no reflux, and complete voiding.
CI  - (c) 2017 The Authors BJU International (c) 2017 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Minervini, Andrea
AU  - Minervini A
AUID- ORCID: 0000-0001-5140-4628
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Vanacore, Davide
AU  - Vanacore D
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Vittori, Gianni
AU  - Vittori G
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Milanesi, Martina
AU  - Milanesi M
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Tuccio, Agostino
AU  - Tuccio A
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Siena, Giampaolo
AU  - Siena G
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Campi, Riccardo
AU  - Campi R
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Mari, Andrea
AU  - Mari A
AD  - Department of Urology, University of Florence, Florence, Italy.
FAU - Gavazzi, Andrea
AU  - Gavazzi A
AD  - Azienda Sanitaria di Firenze (ASF), Florence, Italy.
FAU - Carini, Marco
AU  - Carini M
AD  - Department of Urology, University of Florence, Florence, Italy.
LA  - eng
PT  - Journal Article
DEP - 20171211
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Aged
MH  - Anastomosis, Surgical
MH  - Female
MH  - Humans
MH  - Ileum/*surgery
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Postoperative Complications/etiology
MH  - Practice Guidelines as Topic
MH  - Plastic Surgery Procedures/adverse effects/*methods
MH  - Robotic Surgical Procedures/adverse effects/*methods
MH  - Treatment Outcome
MH  - Urethra/*surgery
MH  - Urinary Bladder Neoplasms/*surgery
MH  - *Urinary Reservoirs, Continent/physiology
MH  - Urination
MH  - Urodynamics
OTO - NOTNLM
OT  - IDEAL guidelines
OT  - intracorporeal
OT  - orthotopic ileal neobladder
OT  - robot-assisted radical cystectomy
OT  - urinary diversion
EDAT- 2017/11/16 06:00
MHDA- 2018/03/14 06:00
CRDT- 2017/11/16 06:00
PHST- 2017/11/16 06:00 [pubmed]
PHST- 2018/03/14 06:00 [medline]
PHST- 2017/11/16 06:00 [entrez]
AID - 10.1111/bju.14077 [doi]
PST - ppublish
SO  - BJU Int. 2018 Feb;121(2):313-317. doi: 10.1111/bju.14077. Epub 2017 Dec 11.