Intracorporeal vs. extracorporeal approaches to W configuration neobladders after robot-assisted radical cystectomy

Introduction: We sought to compare robot-assisted intracorporeal (IC) to W orthotopic ileal neobladder to extracorporeal (EC) approach. Methods: A retrospective review of our robot-assisted radical cystectomy (RARC) database was performed. No conversion to open surgery was done. We identified patients who underwent IC and EC neobladders (W configuration) and compared their short-term perioperative outcomes. Results: 39 patients received neobladders (33 EC and six IC). Both groups showed comparable preoperative characteristics except for body mass index (BMI) (IC group showed higher BMI: 33 vs. 28; p=0.03). Although there was no significant difference in the diversion time, IC patients exhibited shorter overall operative time (374 vs. 446 minutes; p=0.04). They experienced less blood loss (183 vs. 426 ml; p=0.02). They had shorter hospital stay (5 vs. 9 days; p=0.001) but longer ICU stay (3 vs. 1 day; p=0.009). Fewer patients experienced overall complications (50% vs. 90%; p\u3c0.001) but similar high-grade complications. Conclusions: Patients with IC neobladders showed better short-term perioperative outcomes when compared to EC approach