Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic.

OBJECTIVES: To evaluate and compare the morbidity and mortality of cystectomy-ileal conduit urinary diversion in patients with neurogenic lower urinary tract dysfunction according to the surgical approach, and to evaluate predictive factors of early and late morbidity. METHODS: This was a single-center retrospective study based on 65 patients operated between May 2005 and December 2011. The surgical approach consisted of: laparotomy (n = 11), laparoscopy (n = 14) and robotic (n = 40). Evaluation of early (<30 days) and late (>30 days) morbidity and mortality was carried out according to the Clavien-Dindo classification. RESULTS: The operating time was longer (P = 0.007) and the mean time to return of bowel function was shorter (P = 0.012) in the robotic group. The early complication rate for the overall population was 41.5%: minor complications in 32.3% of cases and major complications in 9.2% of cases. A tendency towards a lower minor complication rate was observed in favor of robotic surgery (P = 0.08), with a reduction of the postoperative hemorrhagic complication rate (P = 0.03). The late complication rate for the overall population was 43.1%: minor complications in 20% and major complications in 23.1%. A lower surgical revision rate under general anesthesia was observed in favor of robotic surgery (P = 0.03). No predictive factor of early and late morbidity was identified. CONCLUSION: Robotic cystectomy-ileal conduit urinary diversion in patients with neurogenic lower urinary tract dysfunction is feasible and safe. Its morbidity in experienced hands seems to be limited and comparable with laparoscopy or open surgery.

Pelvic schwannoma: robotic laparoscopic resection.

BACKGROUND: Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. OBJECTIVE: To describe the operative steps and technical aspects of robotic laparoscopic resection of pelvic schwannoma. METHODS: We describe 2 patients with pelvic schwannoma: a 34-year-old woman with schwannoma of the right lumbosacral trunk and a 58-year-old woman with schwannoma of a left S1 nerve. Pain was the main symptom in both patients. The diagnosis was confirmed by magnetic resonance imaging and nerve biopsies. Both patients were operated on by robotic laparoscopy. RESULTS: Lesions were totally enucleated after incising the epineurium. After dissection of the schwannoma, the vascular pedicle and nerve fascicles involved were identified, coagulated, and then sectioned. The remaining fascicles of the nerve were preserved. The postoperative course was uneventful in both patients. With follow-up of 9 and 13 months, both patients obtained complete pain relief with no neurological sequelae. CONCLUSION: Robotic laparoscopic resection of pelvic nerve tumors such as schwannomas is technically feasible.