Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Perioperative Management and Operative Technique
4 affiliations
- 1Department of Urology, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06520, USA
- 2Department of Anesthesia, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT 06520, USA
- 3Pre-Surgical Evaluation Clinic, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA
- 4Division of Surgery and Interventional Science, Charles Bell House, 43–45 Foley Street, London W1W 7TS, UK
Abstract
Radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive bladder cancer and selected high-risk non-muscle-invasive disease. The procedure carries substantial morbidity, in part because the typical patient is elderly and burdened by cardiorespiratory comorbidity. Robot-assisted radical cystectomy (RARC) was developed to attenuate this morbidity, and RARC with intracorporeal urinary diversion (iRARC) avoids the laparotomy that earlier randomized trials required for extracorporeal reconstruction. In this technical narrative review, we present a single-institution operative approach to iRARC, distinguishing institutional practice from evidence-based recommendations. We describe patient selection, preoperative optimization and enhanced recovery, and provide a step-by-step account of our operative technique for male and female radical cystectomy, pelvic lymph node dissection template, and totally intracorporeal ileal conduit and orthotopic neobladder reconstruction. We also summarize the perioperative, oncological, and functional outcomes of iRARC, which support its role as a safe option with specific perioperative advantages in experienced, high-volume centers.
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BibTeX
@article{zillo2026robotassisted,
title = {{Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Perioperative Management and Operative Technique}},
author = {Cristofer Zillo and Ashti Shah and Agustin Perez-Londono and Jinlei Li and Zyad J. Carr and Fady Ghali and Wei Shen Tan},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207858},
url = {https://www.mdpi.com/2077-0383/15/20/7858},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Perioperative Management and Operative Technique
AU - Cristofer Zillo
AU - Ashti Shah
AU - Agustin Perez-Londono
AU - Jinlei Li
AU - Zyad J. Carr
AU - Fady Ghali
AU - Wei Shen Tan
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207858
UR - https://www.mdpi.com/2077-0383/15/20/7858
AB - Radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive bladder cancer and selected high-risk non-muscle-invasive disease. The procedure carries substantial morbidity, in part because the typical patient is elderly and burdened by cardiorespiratory comorbidity. Robot-assisted radical cystectomy (RARC) was developed to attenuate this morbidity, and RARC with intracorporeal urinary diversion (iRARC) avoids the laparotomy that earlier randomized trials required for extracorporeal reconstruction. In this technical narrative review, we present a single-institution operative approach to iRARC, distinguishing institutional practice from evidence-based recommendations. We describe patient selection, preoperative optimization and enhanced recovery, and provide a step-by-step account of our operative technique for male and female radical cystectomy, pelvic lymph node dissection template, and totally intracorporeal ileal conduit and orthotopic neobladder reconstruction. We also summarize the perioperative, oncological, and functional outcomes of iRARC, which support its role as a safe option with specific perioperative advantages in experienced, high-volume centers.
SN - 2077-0383
ER -