Step by step technique of Stentless Florence Robotic Intracorporeal Neobladder (FloRIN), does the ureteral management influence functional outcomes?

Luca Lambertini; Fabrizio Di Maida; Anna Cadenar; Antonio Andrea Grosso; Francesca Valastro; Mara Bacchiani; Sofia Giudici; Alessandro Sandulli; Filippo Lipparini; Vincenzo Salamone; Daniele Paganelli; Simone Coco; Andrea Mari; Andrea Minervini

doi:10.1177/03915603241252908

Step by step technique of Stentless Florence Robotic Intracorporeal Neobladder (FloRIN), does the ureteral management influence functional outcomes?

Urologia. 2024 May 16:3915603241252908. doi: 10.1177/03915603241252908. Online ahead of print.

Authors

Luca Lambertini^{1

2}, Fabrizio Di Maida^{1

2}, Anna Cadenar^{1

2}, Antonio Andrea Grosso^{1

2}, Francesca Valastro^{1

2}, Mara Bacchiani^{1

2}, Sofia Giudici^{1

2}, Alessandro Sandulli^{1

2}, Filippo Lipparini^{1

2}, Vincenzo Salamone^{1

2}, Daniele Paganelli^{1

2}, Simone Coco^{1

2}, Andrea Mari^{1

2}, Andrea Minervini^{1

2}

Affiliations

¹ Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

PMID: 38752506
DOI: 10.1177/03915603241252908

Abstract

Introduction: Benefits and harms of avoid the sent placement during IntraCorporeal Neobladder configuration are still debated. Our objective was to describe the step-by-step technique of Florence intracorporeal neobladder (FloRIN) configuration performed with stentless procedure focusing on perioperative and mid-term functional outcomes.

Materials and methods: In this single institution prospective randomized 1:1 series all consecutive patients underwent Robot-Assisted Radical Cystectomy (RARC) and FloRIN reconfiguration from January 2021 to March 2021 were enrolled. Functional perioperative and mid-term outcomes were gathered. Postoperative complications were graded according to Clavien-Dindo classification and divided in early (<30 days from discharge) and delayed (>30 days).

Results: Overall, 10 patients were included in the analysis. Of these, the 50.0% was treated with Stentless FloRIN. In terms of baseline features, no differences were recorded between the two groups. Median age was 65 and 66 years while median BMI was 27 and 25 in the stentless and in the stent group, respectively. Concerning intraoperative variables, no intraoperative complications as well as open conversion occurred among both groups. As regard introperative features, a shorter console time was associated with stentless procedure (331 min vs 365 min). In terms of perioperative outcomes, canalization and time to drainage removal didn't differ between groups while length of hospital stay was significantly lower in stentless group 10 days versus 14 days. Early and delayed postoperative complication rate was not influenced by the ureteral management at a preliminary assessment with comparable rates of Clavien Dindo ⩾ 3a between the two groups. Mid-term functional outcomes did not differ between groups in terms of kidney function loss.

Conclusions: FloRIN with Stentless technique showed functional and perioperative preliminary outcomes comparable with the standard ureteral management strategy. Further series with longer functional follow-up assessment will be needed to confirm our preliminary results.

Keywords: Bladder cancer; IntraCorporeal neobladder; perioperative complications; robotic neobladder; ureteral stenting.