Stapled vs totally handsewn robotic intracorporeal neobladder: perioperative and functional outcomes

ObjectivesTo compare perioperative, postoperative and functional outcomes between stapled (ST) and handsewn (HS) intracorporeal orthotopic neobladder (iON) configuration during robot‐assisted radical cystectomy (RARC).Patients and MethodsOur single centre institutional bladder cancer dataset was queried for ‘RARC’ ‘stapled’ and ‘handsewn’ iON. Baseline, peri‐ and postoperative features of patients treated between January 2018 and July 2023 were collected. Continuous and categorical variables were compared using Kruskal–Wallis and chi‐square tests. The Kaplan–Meier method was applied to assess functional outcomes. Cox regression analysis was performed to identify predictors of continence recovery.ResultsOverall, 116 patients were enrolled (HS‐iON, 60 patients). There were no differences in perioperative outcomes, except for the hospital length of stay, being shorter in the HS‐iON cohort (P < 0.001). There were no differences in the 30‐ (P = 0.17) and 90‐day (P = 0.69) postoperative complications. The stone rate was lower in the HS‐iON cohort (P = 0.01). At Kaplan–Meier analysis, patients with HS‐iON had higher day‐ (P < 0.001) and night‐time (P < 0.001) continence recovery probabilities. At multivariable analysis, the only independent predictor of continence recovery was ‘sex‐sparing approach’. Excluding patients who underwent sex‐sparing procedures, the HS approach was the only predictor of night‐time continence recovery (hazard ratio 2.6, 95% confidence 1.27–5.34; P = 0.009).ConclusionHand sewing may represent a preferable option for iON configuration during RARC. ST‐iON did not prove to either reduce operative times or perioperative complications, while seemed to significantly impact on the risk of stone formation and continence recovery. Whenever oncologically feasible, a sex‐sparing approach should be preferred to improve day‐ and night‐time continence recovery.