The Urethra Anastomosiis in Orthotopic Neobladder following Robot-Assisted Radical Cystectomy (RARC) at German-Speaking Centres

Introduction: Following robot-assisted radical cystectomy (RARC) and extracorporeal reconstruction, robotic continuous suture techniques and those using open or robotically pre-positioned single sutures are used for the urethroneovesical anastomosis. Methods: 62 German-speaking robotic centres were asked in an online questionnaire whether they carried out RARC. Following an affirmative answer further questions were put to the form of the neobladder and the technique of the urethrovesical anastomosis. Results: 80% of the online questionnaires were answered. 44% (n = 22) of these centres perform the RARC. According to the answers, given all of the centres but one perform an extracorporeal construction of the neobladder [Studer bladder 73% (n = 16), Hautmann bladder 18% (n = 4), others 9% (n = 2)]. After reconstruction 36% (n = 8) of the teams perform a completely open surgical anastomosis with pre-positioned sutures, 24% (n = 5) close the anastomosis in a single knot technique using robotically pre-positioned sutures and 40% (n = 9) use continuous sutures during the intracorporeal reconstruction or after re-docking the robot. Conclusion: According to this questionnaire to German-speaking centres the most common anastomotic technique following extracorporeal reconstruction, mostly a Studer bladder, is that of the pre-positioned single knot sutures. This offers the advantage that a re-docking of the robotic cart is unnecessary. In contrast, however, to robotically performed suturing, there must be enough space in the open procedure to surgically tie-off the sutures of the anastomosis.