Recommendation of performing ECUD for inexperienced urologists of RARC

• Published in: Japanese Journal of Endourology and Robotics Vol. 37; no. 1; pp. 9 - 14
• Main Authors: 今村 亮一, 加藤 大悟, 波多野 浩士, 河嶋 厚成, 福原 慎一郎, 野々村 祝夫
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Endourology and Robotics 2024; 一般社団法人 日本泌尿器内視鏡・ロボティクス学会
• Subjects: ECUD; ICUD; ロボット支援腹腔鏡下膀胱全摘除術; 尿路変向術
• ISSN: 2436-875X
• DOI: 10.11302/jserjje.37.1_9

  Radical cystectomy (RC) is a gold standard procedure for muscle-invasive bladder cancer. Instead of open radical cystectomy, robot-assisted radical cystectomy (RARC) is gradually becoming more popular, and the number of the surgery undergone has increased worldwide as minimally invasive surgery. However, it is well known that RARC is one of the most challenging surgeries for inexperienced urologists. Surgeons performing RC is required high quality perioperative and postoperative outcomes. When performing this procedure, we must achieve the RC-pentafecta : negative soft tissue surgical margins, ≧16 lymph nodes yield, absence of major complications at 90 days, absence of urinary diversion-related surgical sequelae at ≦12 months, and absence of clinical recurrence at ≦12 months. Completing RC, it is required to perform multiple steps : removal of the bladder and other organs (including prostate, seminal vesicles, distal ureters, [and urethra] for men, and adjacent vagina, uterus, distal ureters and urethra for women), dissection of pelvic lymph nodes, and performing urinary diversion. Therefore, it is difficult for inexperienced urologists to complete all steps. Suppose they can perform even one of these procedures with prior experience. In that case, it will not only lead to shorter operation time and less stress, but it may also be possible to perform high-quality surgeries. Many urologists have experienced performing an ileal conduit as a urinary diversion in the era of open surgery. Therefore, extracorporeal urinary diversion (ECUD) is a familiar procedure for urologists and is easy to accept. This paper explains the advantages and disadvantages of ECUD and intracorporeal urinary diversion (ICUD), why ECUD is recommended to inexperienced urologists, and the surgical techniques for ECUD.