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Urinary Bladder Neoplasms: HELP
Articles by Christofer Adding
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, C. Adding wrote the following 11 articles about Urinary Bladder Neoplasms.
 
+ Citations + Abstracts
1 Review Enhanced recovery protocols (ERP) in robotic cystectomy surgery. Review of current status and trends. 2015

Adding, Christofer / Collins, Justin W / Laurin, Oscar / Hosseini, Abolfazl / Wiklund, N Peter. ·Department of Urology, Karolinska University Hospital, 171 76, Stockholm, Sweden, christofer.adding@karolinska.se. ·Curr Urol Rep · Pubmed #25850413.

ABSTRACT: Open radical cystectomy with pelvic lymphadenectomy and urinary diversion is associated with a high complication rate. Robotic-assisted laparoscopic radical cystectomy is increasingly performed in many urologic surgical departments in an effort to reduce surgical stress and decrease perioperative morbidity. Robotic cystectomy survival studies demonstrate similar oncologic outcomes compared to the open procedure. Enhanced recovery protocols (ERP) after major surgery are multimodal perioperative interventions to reduce surgical stress, complications, and patient convalescence. Evidence for different ERP interventions are currently mainly from colorectal surgery and recently adapted to major urologic operations including cystectomy. Guidelines for perioperative care after open radical cystectomy for bladder cancer were recently published, but these recommendations may differ when considering a robotic approach. Therefore, we look at the current evidence for ERP in both open and robotic radical cystectomy and the potential for improving ERPs in robotic cystectomy by utilizing a totally intracorporeal robotic cystectomy approach. We also present the Karolinska ERP currently utilized in totally intracorporeal robotic cystectomy.

2 Article Robot-assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes - a single institution experience. 2020

Hosseini, Abolfazl / Mortezavi, Ashkan / Sjöberg, Siri / Laurin, Oscar / Adding, Christofer / Collins, Justin / Wiklund, Peter N. ·Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden. · Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. · Department of Urology, UCLH, London, UK. · Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ·BJU Int · Pubmed #32403199.

ABSTRACT: OBJECTIVE: To report a single institution experience with totally intracorporeal neobladder urinary diversion after robot-assisted laparoscopic radical cystectomy (RARC). PATIENTS AND METHODS: A total of 158 patients underwent totally intracorporeal neobladder urinary diversion after RARC between 2003 - 2016. Patient demographics, intraoperative- and pathologic data, 30-d and 90-d perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. Five year overall and disease-specific survival rates were estimated by Kaplan-Meier plots. RESULTS: The majority of the patients were male (84%) and had clinically T-stage ≤2 (87%). Mean operation time was 359 min (SD ±98) with a median estimated blood loss of 300ml (50-2200). Most of the men (86%) received a nerve-sparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) cases with a median yield of 23 (7-48). Conversion to open surgery occurred in 5 patients (3%). We recorded negative margins in 156 patients (99%). Median follow-up time was 34 months (1-170) with a 30-d and 90-d mortality rate of 0%. Clavien III-IV complications occurred in 29 of 158 (18%) patients at 30-d and in 8 of 158 (5%) between 30-90d resulting into a 90-d overall high-grade complication rate of 23%. The unadjusted estimated 5y recurrence-free (RFS), cancer specific (CSS) and overall survival (OS) rates were 70%, 72%, and 71%, respectively. CONCLUSION: In our series, the complication and oncologic results were similar to open radical cystectomy series, suggest that RARC followed by totally intracorporeal neobladder urinary diversion is a safe and feasible alternative.

3 Article Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach. 2020

Chessa, F / Möller, A / Collins, J / Laurin, O / Aly, M / Schiavina, R / Adding, C / Distefano, C / Akre, O / Bertaccini, Alessandro / Hosseini, A / Brunocilla, E / Wiklund, P. ·Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Palagi 9 street, 40134, Bologna, Italy. francesco.chessa3@unibo.it. · S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy. francesco.chessa3@unibo.it. · Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy. francesco.chessa3@unibo.it. · Department of Molecular Medicine and Surgery Section of Urology Stockholm, Karolinska Institutet, Stockholm, Sweden. francesco.chessa3@unibo.it. · Department of Molecular Medicine and Surgery Section of Urology Stockholm, Karolinska Institutet, Stockholm, Sweden. · Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Palagi 9 street, 40134, Bologna, Italy. · S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy. · Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy. · Department of Urology, Icahn School of Medicine, Mount Sinai, NY, USA. ·J Robot Surg · Pubmed #32367438.

ABSTRACT: BACKGROUND: Incidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC). METHODS: The clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pathological examinations were stratified in two groups, according to the preservation of the neurovascular bundles (nerve sparing vs no nerve sparing). Significant PCa was defined as any Gleason score ≥ 3 + 4. Biochemical recurrence (BR) was defined as a sustained PSA level > 0.2 ng/mL on two or more consecutive appraisals. BR rate was assessed only in patients with incidental prostate cancer and at least 2 years of follow-up. Differences in categorical and continuous variables were analysed using the chi-squared test and the Mann-Withney U test, respectively. Biochemical recurrence curves were generated using the Kaplan-Meier method and compared with the Log-rank test. RESULTS: Overall, 343 male patients underwent RARC for bladder cancer within the study period. Nerve-sparing surgery was performed in 143 patients (41%), of these 110 had at least 2 years of follow up after surgery. Patients who underwent nerve-sparing surgery were significantly younger (p < 0.001). Clinically significant PCa was found in 24% of patients. No significant differences regarding preoperative PSA value (p = 0.3), PCa pathological stage (p = 0.5), Gleason score (p = 0.3) and positive surgical margin rates (p = 0.3) were found between the two groups. After a median follow-up of 51 months only one patient, in the no-nerve-sparing group had developed a biochemical recurrence (p = 0.4). CONCLUSIONS: In our series most of the iPca detected in RC specimens can be considered as insignificant with a low rate of BR (0.9%). Nerve-sparing RARC is a safe procedure which did not affect oncological outcomes of patients with iPCa.

4 Article Evolution of cystectomy care over an 11-year period in a high-volume tertiary referral centre. 2018

Brassetti, Aldo / Möller, Axel / Laurin, Oscar / Höijer, Jonas / Adding, Christofer / Miyakawa, Ayako / Hosseini, Abolfazl / Wiklund, Peter. ·Department of Molecular Medicine and Surgery Section of Urology, Karolinska Institutet, Stockholm, Sweden. · Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. ·BJU Int · Pubmed #29281852.

ABSTRACT: OBJECTIVES: To describe the evolution in radical cystectomy (RC) care over 11 years at a referral centre. PATIENTS AND METHODS: The clinical data of patients undergoing either open RC (ORC) or robot-assisted RC (RARC) for cT1-4aN0M0 bladder cancer (BCa) at our centre between January 2006 and December 2016 were retrospectively evaluated. Crude and propensity score-weighted log-binomial regression analyses were conducted to assess the association between pre- and peri-operative variables and the risk of reoperation, intensive care unit (ICU) admission and death <90 days after RC. RESULTS: A total of 814 patients were considered. The percentage of RARCs performed increased (from 10% to 100%) between 2006 and 2013. Overall, 29% of the patients received neoadjuvant chemotherapy (12-37% from 2006 to 2016). Despite no differences in terms of operating time, pelvic lymph node dissection (PLND) was more commonly attempted during RARC and extended PLND was more frequently performed in the RARC group (72% vs 19%; P < 0.001). Ileal conduit was the preferred urinary diversion in both groups, and more patients in the RARC group underwent neobladder construction (34% vs 14%; P < 0.001). The overall rates of re-intervention, ICU admission and death within 90 days of RC were 8.9%, 5.4% and 2.9%, respectively. On crude analysis, RARC was associated with a reduced risk of ICU admission (relative risk [RR] 0.42, 95% confidence interval [CI] 0.23-0.77; P = 0.005), reintervention (RR 0.58, 95% CI 0.37-0.90; P = 0.015) and death (RR 0.37, 95% CI 0.16-0.85; P = 0.020); however, these risk reductions were not statistically significant on weighted analyses. CONCLUSIONS: The introduction of RARC has coincided with a reduction in the rate of ICU admission, reoperation and death within 90 days of surgery, without compromising operating time, PLND extent or neobladder utilization.

5 Article Early Recurrence Patterns Following Totally Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section (ERUS) Scientific Working Group. 2017

Collins, Justin W / Hosseini, Abolfazl / Adding, Christofer / Nyberg, Tommy / Koupparis, Anthony / Rowe, Edward / Perry, Matthew / Issa, Rami / Schumacher, Martin C / Wijburg, Carl / Canda, Abdullah E / Balbay, Mevlana / Decaestecker, Karel / Schwentner, Christian / Stenzl, Arnulf / Edeling, Sebastian / Pokupić, Saša / D'Hondt, Fredrik / Mottrie, Alexander / Wiklund, Peter N. ·Karolinska University Hospital, Stockholm, Sweden. · Karolinska Institute, Stockholm, Sweden. · Bristol Urological Institution, Bristol, UK. · St. Georges Hospital London, London, UK. · Hirslanden Klinik, Aarau, Switzerland. · Carl Wijburg, Rijnstate, Arnhem, The Netherlands. · Ankara Ataturk Hospital, Ankara, Turkey. · Memorial Sisli Hospital, Istanbul, Turkey. · Ghent University Hospital, Ghent, Belgium. · University of Tübingen, Tübingen, Germany. · Da Vinci Zentrum, Hanover, Germany. · O.L.V, Clinic, Aalst, Belgium. · Karolinska University Hospital, Stockholm, Sweden. Electronic address: peter.wiklund@karolinska.se. ·Eur Urol · Pubmed #27816299.

ABSTRACT: Recurrence following radical cystectomy often occurs early, with >80% of recurrences occurring within the first 2 yr. Debate remains as to whether robot-assisted radical cystectomy (RARC) negatively impacts early recurrence patterns because of inadequate resection or pneumoperitoneum. We report early recurrence patterns among 717 patients who underwent RARC with intracorporeal urinary diversion at nine different institutions with a minimum follow-up of 12 mo. Clinical, pathologic, radiologic, and survival data at the latest follow-up were collected. Recurrence-free survival (RFS) estimates were generated using the Kaplan-Meier method, and Cox regression models were built to assess variables associated with recurrence. RFS at 3, 12, and 24 mo was 95.9%, 80.2%, and 74.6% respectively. Distant recurrences most frequently occurred in the bones, lungs, and liver, and pelvic lymph nodes were the commonest site of local recurrence. We identified five patients (0.7%) with peritoneal carcinomatosis and two patients (0.3%) with metastasis at the port site (wound site). We conclude that unusual recurrence patterns were not identified in this multi-institutional series and that recurrence patterns appear similar to those in open radical cystectomy series. PATIENT SUMMARY: In this multi-institutional study, bladder cancer recurrences following robotic surgery are described. Early recurrence rates and locations appear to be similar to those for open radical cystectomy series.

6 Article Introducing an enhanced recovery programme to an established totally intracorporeal robot-assisted radical cystectomy service. 2016

Collins, Justin W / Adding, Christofer / Hosseini, Abolfazl / Nyberg, Tommy / Pini, Giovannalberto / Dey, Linda / Wiklund, Peter N. ·a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden. · b 2 Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institutet , Stockholm, Sweden. ·Scand J Urol · Pubmed #26313582.

ABSTRACT: OBJECTIVE: The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. MATERIALS AND METHODS: Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC. Patient demographics and outcomes before and after implementation of the ERP were compared. The primary endpoint was length of stay (LOS). Secondary outcomes included age, American Society of Anesthesiologists (ASA) score, preoperative staging, operative time, complications and readmissions. Differences in outcomes between patients before and after implementation of ERP were tested with the Jonckheere-Terpstra trend test and quantile regression with backward selection. RESULTS: Following implementation of the ERP, the demographics of the patients (n = 135) changed, with median age increasing from 66 to 70 years (p < 0.01), higher ASA grade (p < 0.001), higher preoperative stage cancer (pT ≥ 2, p < 0.05) and increased likelihood of undergoing an ileal conduit diversion (p < 0.001). Median LOS before ERP was 9 days [interquartile range (IQR) 8-13 days] and after ERP was 8 days (IQR 6-10 days) (p < 0.001). ASA grade and neoadjuvant chemotherapy also affected LOS (p < 0.05 and p < 0.01, respectively). There was no significant difference in 30 day complication rates, readmission rates or 90 day mortality, with 59% experiencing complications before ERP implementation and 57% after implementation. The majority of complications were low grade. CONCLUSIONS: Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased variability in LOS.

7 Article Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. 2014

Desai, Mihir M / Gill, Inderbir S / de Castro Abreu, Andre Luis / Hosseini, Abolfazl / Nyberg, Tommy / Adding, Christofer / Laurin, Oscar / Collins, Justin / Miranda, Gus / Goh, Alvin C / Aron, Monish / Wiklund, Peter. ·USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden. Electronic address: mihir.desai@usc.edu. · USC Institute of Urology, University of Southern California, Los Angeles, California, and Karolinska Institute, Stockholm, Sweden. ·J Urol · Pubmed #25016136.

ABSTRACT: PURPOSE: We present a 2-institution experience with completely intracorporeal robotic orthotopic ileal neobladder after radical cystectomy in 132 patients. MATERIALS AND METHODS: Established open surgical techniques were duplicated robotically with all neobladders suture constructed intracorporeally in a globular configuration. Nerve sparing was performed in 56% of males. Lymphadenectomy was extended (up to aortic bifurcation in 51, 44%) and superextended (up to the inferior mesenteric artery in 20, 17%). Ureteroileal anastomoses were Wallace-type (86, 65%) or Bricker-type (46, 35%). The learning curve at each institution was assessed using chronological subgroups and by trends across the entire cohort. Data were prospectively collected and retrospectively queried. RESULTS: Mean operating time was 7.6 hours (range 4.4 to 13), blood loss was 430 cc (range 50 to 2,200) and hospital stay was 11 days (median 8, range 3 to 78). Clavien grade I, II, III, IV and V complications within 30 days were 7%, 25%, 13%, 2% and 0%, respectively, and between 30 and 90 days were 5%, 9%, 11%, 1% and 2%, respectively. Mean nodal yield was 29 (range 7 to 164) and the node positivity rate was 17%. Operative time, blood loss, hospital stay and prevalence of late complications improved with experience. During a mean followup of 2.1 years (range 0.1 to 9.8) cancer recurred in 20 patients (15%). Five-year overall, cancer specific and recurrence-free survival was 72%, 72% and 71%, respectively. CONCLUSIONS: We developed a refined technique of robotic intracorporeal orthotopic neobladder diversion, duplicating open principles. Operative efficiency and outcomes improved with experience. Going forward, we propose a prospective randomized comparison between open and robotic intracorporeal neobladder surgery.

8 Article Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder - what is the effect of the learning curve on outcomes? 2014

Collins, Justin W / Tyritzis, Stavros / Nyberg, Tommy / Schumacher, Martin C / Laurin, Oscar / Adding, Christofer / Jonsson, Martin / Khazaeli, Dinyar / Steineck, Gunnar / Wiklund, Peter / Hosseini, Abolfazl. ·Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden. ·BJU Int · Pubmed #24053710.

ABSTRACT: OBJECTIVE: To evaluate the effect of the learning curve on operative, postoperative, and pathological outcomes of the first 67 totally intracorporeal robot-assisted radical cystectomies (RARCs) with neobladders performed by two lead surgeons at Karolinska University Hospital. PATIENTS AND METHODS: Between December 2003 and October 2012, 67 patients (61 men and six women) underwent RARC with orthotopic urinary diversion by two main surgeons. Data were collected prospectively on patient demographics, peri- and postoperative outcomes including operation times, conversion rates, blood loss, complication rates, pathological data and length of stay (LOS) for these 67 consecutive patients. The two surgeons operated on 47 and 20 patients, respectively. The patients were divided into sequential groups of 10 in each individual surgeon's series and assessed for effect of the learning curve. RESULTS: Patient demographics and clinical characteristics were similar in both surgeons' groups. The overall total operation times trended down in both surgeons' series from a median time of 565 min in the first group of 10 cases, to a median of 345 min in the last group for surgeon A (P < 0.001) and 413 to 385 min for surgeon B (not statistically significant). Risk of conversion to open surgery also decreased with a 30% conversion rate in the first group to zero in latter groups (P < 0.01). Overall complications decreased as the learning curve progressed from 70% in the first group to 30% in the later groups (P < 0.05), although major complications were not statistically different when compared between the groups. Patient demographics did not change over time. The mean estimated blood loss was unchanged across groups with increasing experience. The pathological staging, mean total lymph node yield and number of positive margins were also unchanged across groups. There was a decrease in LOS from a mean of 19 days in the first group to a mean (range) of 9 (4-78) days in the later groups, although the median LOS was unchanged and therefore not statistically significant. CONCLUSIONS: Totally intracorporeal RARC with intracorporeal neobladder is a complex procedure, but it can be performed safely, with a structured approach, at a high-volume established robotic surgery centre without compromising perioperative and pathological outcomes during the learning curve for surgeons. An experienced robotic team and mentor can impact the learning curve of a new surgeon in the same centre resulting in decreased operation times early in their personal series, reducing conversion rates and complication rates.

9 Article Robot-assisted radical cystectomy: description of an evolved approach to radical cystectomy. 2013

Collins, Justin W / Tyritzis, Stavros / Nyberg, Tommy / Schumacher, Martin / Laurin, Oscar / Khazaeli, Dinyar / Adding, Christofer / Jonsson, Martin N / Hosseini, Abolfazl / Wiklund, N Peter. ·Karolinska University Hospital, Stockholm, Sweden. jwcol@yahoo.co.uk ·Eur Urol · Pubmed #23769588.

ABSTRACT: BACKGROUND: Although open radical cystectomy (ORC) remains the gold standard of care for muscle-invasive bladder cancer, robot-assisted radical cystectomy (RARC) continues to gain wider acceptance. In this article, we focus on the steps of RARC, describing our approach, which has been developed over the past 10 yr. Totally intracorporeal RARC aims to offer the benefits of a complete minimally invasive approach while replicating the oncologic outcomes of open surgery. OBJECTIVE: We report our outcomes of a totally intracorporeal RARC procedure, describing step by step our technique and highlighting the variations on this standard template of nerve-sparing and female organ-preserving approaches in men and women. DESIGN, SETTING, AND PARTICIPANTS: Between December 2003 and October 2012, a total of 113 patients (94 male and 19 female) underwent totally intracorporeal RARC. SURGICAL PROCEDURE: We performed RARC, extended pelvic lymph node dissection, and a totally intracorporeal urinary diversion (UD) in all patients. In the accompanying video, we focus on the standard template for RARC, also describing nerve-sparing and female organ-preserving approaches. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Complications and oncologic outcomes are reported, including overall survival (OS) and cancer-specific survival (CSS) using Kaplan-Meier analysis. RESULTS AND LIMITATIONS: RARC with intracorporeal UD was performed in 113 patients. Mean age was 64 yr (range: 37-84). Forty-three patients underwent intracorporeal ileal conduit, and 70 had intracorporeal neobladder. On surgical pathology, 48% of patients had ≤ pT1 disease, 27% had pT2 disease, 13% had pT3 disease, and 12% had pT4 disease. The mean number of lymph nodes removed was 21 (range: 0-57). Twenty percent of patients had lymph node-positive disease. Positive surgical margins occurred in six cases (5.3%). Median follow-up was 25 mo (range: 3-107). We recorded a total of 70 early complications (0-30 d) in 54 patients (47.8%), with 37 patients (32.7%) having Clavien grade ≥ 3. Thirty-six late complications (>30 d) were recorded in 30 patients (26.5%), with 20 patients (17.7%) having Clavien grade ≥ 3. One patient (0.9%) died within 90 days of operation from pulmonary embolism. Using Kaplan-Meier analysis, CSS was 81% at 3 yr and 67% at 5 yr. CONCLUSIONS: Our structured approach to RARC has enabled us to develop this complex service while maintaining patient outcomes and complication rates comparable with ORC series. Our results demonstrate acceptable oncologic outcomes and encouraging long-term CSS rates.

10 Article Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. 2013

Tyritzis, Stavros I / Hosseini, Abolfazl / Collins, Justin / Nyberg, Tommy / Jonsson, Martin N / Laurin, Oscar / Khazaeli, Dinyar / Adding, Christofer / Schumacher, Martin / Wiklund, N Peter. ·Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden. ·Eur Urol · Pubmed #23768634.

ABSTRACT: BACKGROUND: Robot-assisted radical cystectomy (RARC) with totally intracorporeal neobladder diversion is a complex procedure that has been reported with good outcomes in small series. OBJECTIVE: To present complications and oncologic and functional outcomes of this procedure. DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2012 in a tertiary referral center, 70 patients were operated on by two experienced robotic surgeons. Data were collected prospectively and reviewed retrospectively. INTERVENTION: RARC with totally intracorporeal modified Studer ileal neobladder formation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The overall outcome of RARC with a totally intracorporeal neobladder was presented by assessing (1) surgical margins, (2) recurrence or cancer-specific death at 24 mo, (3) 30-d and 90-d complications graded according to the modified Clavien-Dindo system, (4) daytime and nighttime continence (no or one pad per day) at 6 and 12 mo, and (5) satisfactory sexual activity or potency at 6 mo and 12 mo. Survival rates were estimated by Kaplan-Meier plots. RESULTS AND LIMITATIONS: Median follow-up of the cohort was 30.3 mo (interquartile range: 12.7-35.6). We recorded negative margins in 69 of 70 patients (98.6%). Clavien 3-5 complications occurred in 22 of 70 patients (31.4%) at 30 d and 13 of 70 (18.6%) at >30 d. At 90 d, the overall complication rate was 58.5%. Clavien <3 and Clavien ≥3 complications were recorded in 15 of 70 patients (21.4%) and 26 of 70 (37.1%), respectively. Kaplan-Meier estimates for recurrence-free, cancer-specific, and overall survival at 24 mo were 80.7%, 88.9%, and 88.9%, respectively. Daytime continence and satisfactory sexual function or potency at 12 mo ranged between 70% and 90% in both men and women. Limitations of this study include its retrospective design, selection bias due to the learning curve phase, and missing data. CONCLUSIONS: In this expert center for RARC, outcomes after RARC with totally intracorporeal neobladder diversion appear satisfactory and in line with contemporary open series.

11 Article Robotic cystectomy: surgical technique. 2011

Hosseini, Abolfazl / Adding, Christofer / Nilsson, Andreas / Jonsson, Martin N / Wiklund, N Peter. ·Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden. abolfazl.hosseini-aliabad@karolinska.se ·BJU Int · Pubmed #21917098.

ABSTRACT: OBJECTIVE: • The aim of this report is to describe our surgical technique of robotic assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion in patients with urinary bladder cancer. PATIENTS AND METHODS: • A total of 45 patients (7 women and 38 men) with high-grade and/or muscle-invasive urothelial cancer of the bladder underwent RARC and intracorporeal urinary diversion at our department. • Orthotopic ileal neobladder was performed in 36 patients and ileal conduit was performed in 9 patients. RESULT: • Except in two patients that operation was converted to open surgery during the reconstruction of the orthotopic neobladder, the procedure was performed totally intracorporeal. • The operations time, estimated blood loss and length for hospital stay were decreased over the time. CONCLUSION: • RARC with totally intracorporeal urinary diversion is feasible.