Separated Transfixing Uretero-Enteral Anastomosis Method in Robot-Assisted Radical Cystectomy with Ileal Conduit: Early Induction Experience.

Abstract

Introduction: This study aimed to evaluate the initial outcomes of a novel transfixing uretero-enteral anastomosis technique in robot-assisted radical cystectomy (RARC) with ileal conduit in an intracorporeal urinary diversion (ICUD), focusing on its potential to reducing the incidence of uretero-enteric anastomotic stricture.

Methods: The study subjects were 11 patients who underwent RARC and ileal conduit created as an ICUD at a single cancer center between 2022 and 2024. The technique involved opening the ventral side of the oral end of the separated ileum approximately 5 cm apart. Two small holes were made 2 cm from the oral end on the dorsal side, through which the ureter passed to the luminal side. The distal end of the ureter was spatulated, and four knotted sutures were placed at the base using 4-0 absorbable sutures. The distal end of the ureter was anchored using two knotted sutures, and the liberated portion was closed using 3-0 absorbable suture in a running fashion.

Results: The median total operation time was 418 min (range: 269-467 min), with a median console time of 93 min (range: 80-129 min) for urinary diversion. Two patients required temporary stent reinsertion because of hydronephrosis; however, no pyelonephritis occurred. Two patients (18.2%) had complications of Clavien-Dindo classification 3 or higher, both of which only required temporary stent reinsertion. Postoperative renal function was preserved in all the patients.

Conclusions: In our initial experience, the transfixing uretero-enteral anastomosis technique was successful in stabilizing anastomoses in ICUD.