937 ROBOT-ASSISTED INTRA-CORPOREAL ILEAL CONDUIT: MARIONETTE TECHNIQUE AND INITIAL EXPERIENCE AT ROSWELL PARK CANCER INSTITUTE

Vol. 183, No. 4, Supplement, Monday, May 31, 2010

THE JOURNAL OF UROLOGY姞

patient made an “appropriate” decision. An “appropriate” decision was defined as NS in organ-confined disease and NNS in invasive disease regardless of positivity of margins given the dependence of margin status on the surgeon and not the biology of the patient’s disease. RESULTS: Of the 150 patients, 109 chose NS surgery and 41 chose NNS surgery (Table 1). Overall, patients who had a less than 20% nomogram-predicted risk of ECE chose NS 88% of the time. Those with a risk of ECE of 20-50% chose NS only 41% of the time, while 75% of patients with a predicted risk of greater than 50% chose NNS. Of those who chose NS, 86% had organ-confined disease on final pathology while 59% of those who chose NNS had locally-invasive disease on final pathology. Among the 15 patients who chose NS but had pT3 disease, 13 patients (87%) had a ⬍50% preoperative risk of ECE. Among the 17 patients who chose NNS but had pT2 disease, 9 patients (53%) had a ⬍20% preoperative risk of ECE. CONCLUSIONS: Patient-directed NS did not lead to a high rate of patients with invasive disease electing for NS. Patients appeared to be more conservative and prioritized cancer control in the majority of cases where ECE risk was high and may have been overly conservative in electing NNS when risk was low. Table 1. Patient characteristics and decision making and postoperative pathology. Chose NS (n⫽109) Chose NNS (n⫽41) Pre-op Gleason 6

82

7

25

17

2

12

8-10 Median PSA

4.9

12

6.5

Stage T1c

82

18

T2a-c

25

21

2

2

T3 ECE Risk ⬍ 20%

82

11

20-50%

22

15

⬎ 50%

5

15

Post-op Gleason 5

1

1

6

45

6

7

59

20

3

13

8-10 Stage pT0

1

1

pT2a-c

92

16

pT3

16

24

Source of Funding: None

e365

Urinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II Podium 25 Monday, May 31, 2010

10:30 AM-12:30 PM

937 ROBOT-ASSISTED INTRA-CORPOREAL ILEAL CONDUIT: MARIONETTE TECHNIQUE AND INITIAL EXPERIENCE AT ROSWELL PARK CANCER INSTITUTE Ste´fanie Seixas-Mikelus*, Abid Hussain, Aaron Blumenfeld, John Nyquist, Rameela Chandrasekhar, Gregory Wilding, Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: To present our technique and initial experience with patients who underwent robot-assisted intra-corporeal creation of ileal conduit and compare them with patients who underwent extra-corporeal ileal diversion after robot-assisted radical cystectomy. METHODS: 26 patients diagnosed with invasive transitional cell carcinoma of the bladder underwent a robot-assisted radical cystectomy with bilateral extended pelvic lymphadenectomy with ileal conduit diversion. Total intra-corporeal ileal conduit creation was performed in the last thirteen patients. Operative data and short-term outcome between the two groups were assessed. The novel surgical technique for intra-corporeal ileal conduit will be presented. RESULTS: The intra-corporeal group (IC) included 2 females and 11 males (mean age 71 years). The extra-corporeal group (EC) included 4 females and 9 males (mean age 66 years). No significant differences were noted between the groups in terms of patient age, BMI, sex, prior surgery or pathologic stage. Overall operative time and intra-operative complications were similar. No significant differences were noted between the two groups in terms of diversion time or estimated blood loss. There were four complications recorded in IC including: non-specific colitis, small bowel obstruction requiring exploratory laparotomy with lysis of adhesions, a urine leak that eventually resolved, but required a temporary nephrostomy tube, and a fourth patient with fever of unknown origin that resolved without intervention. CONCLUSIONS: Robot-assisted intra-corporeal ileal conduit can be accomplished safely with acceptable operative times even during early experience. Larger series with favorable results will be required to add this new paradigm to minimally invasive surgery for bladder cancer. Source of Funding: None

938 ROBOTIC-ASSISTED LAPAROSCOPIC INTRACORPOREAL URINARY DIVERSION Stephen McKim*, Eugene Simopoulos, Angela Smith, Matthew Raynor, Matthew Nielsen, Eric Wallen, Raj Pruthi, Chapel Hill, NC INTRODUCTION AND OBJECTIVES: Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. In most of these series, the urinary diversion has been performed in an extracorporeal fashion. This has been few case reports of an intracorporeal diversion, and little description of the technique of such a procedure. Herein, we report our initial experience with roboticassisted laparoscopic intracorporeal urinary diversion describing stepwise the surgical procedure itself, and evaluating peri-operative and pathologic outcomes of this novel procedure. METHODS: Twelve patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal urinary diversion. Outcome measures evaluated in this series included operative variables, hospital recovery, and complication rate. Comparisons were made to