Perioperative, Oncological and Functional Outcomes of Robot-Assisted Radical Cystectomy with Totally Intracorporeal Neobladder using the Ves.Pa. (Vesica Patavina) Technique

Background: For patients with Muscle Invasive Bladder Cancer (MIBC), radical cystectomy constitutes the main surgical treatment. Implementing a Robot-Assisted Radical Cystectomy (RARC) offers distinct advantages in terms of the patients’ perioperative course and functional outcomes. While the construction of a Totally Intracorporeal Neobladder represents the most critical phase of the surgery, the Ves.Pa. (Vesica Patavina) technique has become an established reconstructive procedure. Objective: To evaluate the perioperative, oncological and functional outcomes of the Ves.Pa. technique for the construction of a Totally Intracorporeal Neobladder after RARC. Materials and Methods: A prospective study was conducted on male and female patients who underwent RARC and reconstruction with Ves.Pa. Neobladder. All procedures were performed by experienced surgeons in a tertiary referral centre. The participants included patients treated for Muscle Invasive Bladder Cancer and Non-Muscle Invasive Bladder Cancer in selected cases. The surgical procedure was Robot-Assisted Radical Cystectomy with Totally Intracorporeal Neobladder using the Ves.Pa. technique. Postoperative and functional outcomes were assessed using the Clavien-Dindo classification and the IPSS and ICIQ-UI SF questionnaires, respectively. Results: A total of 100 patients were treated. The median operative time was 400 min, and the median estimated blood loss was 400 ml. The incidence of high-grade complications was remarkably low, with 6% of the patients experiencing early grade-3 complications and 7% of the patients experiencing late grade-3 complications. The mortality was 0% in the first 90 POD. All patients had clear surgical margins. Recurrence-free survival was 90% at the 12-month follow-up and 84% at the 36-month follow-up. At a median follow-up of 11 months, 53% of the patients had moderate urinary symptoms, and 42% of the patients had moderate urinary incontinence. 21% of the patients were fully continent, while severe urinary incontinence was experienced by approximately 25% of the patients. The median number of pads used was 0 during the day and 1 during the night. Conclusions: RARC with Ves.Pa. intracorporeal neobladder offers promising results for the treatment of patients with bladder cancer. Perioperative outcomes, especially for high-grade complications and mortality, are in agreement with or superior to the best available literature. Furthermore, the technique demonstrates favourable oncological outcomes in terms of recurrence-free survival. Functional outcomes are ultimately acceptable and in agreement with other studies about different neobladder techniques.