To report preliminary functional results and morbidity of robot-assisted laparoscopic continent cutaneous urinary diversion (RALCCUD) in adult patients

Retrospective monocentric study including all consecutive patients who underwent RALCCUD between 2017 and 2020. 

The efferent catheterisable tube was performed using either Yang-Monti or Mitrofanoff principle according to the surgical history, appendix length, and its possibility to reach the abdominal wall. The tube was implanted in the posterior bladder wall, according to lich-gregoir principle. 
In case of supratrigonal cystectomy (SC) with enterocystoplasty (ECP) (persistent detrusor overactivity or low bladder compliance), a posterolateral bladder wall flap of 3 cm width was preserved to implant the tube, according to politano-leadbetter principle. 


The distal efferent tube was then sutured to the skin with a V-shaped skin flap, in an umbilical position.
Patients characteristics and clinical data, including pre and postoperative urodynamic assessment, renal function, stomal and urethral continence and satisfaction were recorded prospectively (preop., 3 months, then yearly). 
Continence was defined as no leakage.

12 patients underwent RALCCUD during the study period (4 Mitrofanoff, 4 Yang-Monti and 4 Casale). Patients’ characteristics are detailed in table 1.
No conversion to open approach was required .
The mean operative time was 378 min (250 ;643). 4 patients underwent concomitant procedure: 3 SC with ECP and 1 AUS for female SUI.
Mean follow-up was 20.9 months (6.2; 43.2).
. Early (< 30 days) and late ( > 30 days) postoperative complications rates of complications Clavien 3 or above were respectively 8% (1/12) and 16% (2/12) with 2 late complications grade 3 as detailed in table 1. 
At last, follow up, all patients were able to self-catheterize through the stoma, the stomal continence rate was 91.6% (11/12) with one patient suffering from a stomal incontinence despite bulking agent injection, and the urethral continence rate was 100%.

In our series, the continence rate was good (91, 6%) and our complication rate is low (16, 6%) even for ileal conduit (Yang-Monti and Casale conduits). 
The mean operative time (was 378 min) was long initially but decrease with an improvement in the last 6 procedures to 308 min. It is comparable to other studies on  pediatric patients (1)  and adult patients ( 2).
One of the limits of our study, is the short follow-up with a mean follow up of 20,9 months but most of the stomal complication occur during the first year after the surgery as shown by Thomas and al (3).
.It seems that RALCCUD could provide short-term very high rate of stomal and urethral continence with a low rate of complications.

RALCCUD in an adult population, especially with neurogenic bladder seems to be safe and feasible

Galansky L, et al. Continent Cutaneous Catheterizable Channels in Pediatric Patients: A Decade of Experience with Open and Robotic Approaches in a Single Center. Eur Urol (2020)
Lecoanet P, Pascal G, Khaddad A, Hubert N, Lemelle JL, Berte N, Capon G. Robot-assisted continent urinary diversion according to the Mitrofanoff principle: results of a bicentric study. World J Urol. 2020 Jul 20.
Thomas JC, Dietrich MS, Trusler L, et al. Continent catheterizable channels and the timing of their complications. J Urol 2006;176(4 Pt 2):1816–20, discussion 1820.