"Δ" Delta neobladder: a novel stentless simplified totally intracorporeal robotic technique

Background: To report the first case series of RARC using a simplified technique for intracorporeal stentless neobladder formation. Methods: From October 2022 to February 2023, 10 patients with high-risk bladder cancer underwent RARC at our Institution. RARC with extended pelvic lymph node dissection and totally intracorporeal neobladder using Hugo RAS system. Surgical steps of this novel reservoir are shown in the complementary video. Continuous data were presented as median and interquartile ranges (IQR) while frequencies and proportions were used to report categorical variables and compared by means of Mann-Whitney U test and Chi-square test, respectively. One-year outcomes were recorded. Results: All procedures were successfully performed. Median console time for neobladder configuration was 192 min (IQR, 170-219). A decrease in median operative time was observed in the second half of the series (305 vs. 322 minutes; P=0.12). Two patients (20%) experienced a minor complication (ileus and UTI, Clavien-Dindo II). At 12-months follow-up, renal function was preserved in all patients. Overall, 12-months daytime and night-time continence rates were 80% and 60%, respectively. The limited number of cases represents the main limitation of the current study. Conclusions: This simplified robotic assisted intracorporeal neobladder technique demonstrates a good safety profile in this series of patients. Simplifying robotic intracorporeal surgical techniques could potentially contribute to its reproducibility and popularization in the urologic community.