Outcomes of Stapled Ileo-Ileal Anastomosis During Robot-Assisted Radical Cystectomy with Urinary Diversion: Points of Technique

Purpose: Radical cystectomy (RC) with urinary diversion (UD) is a complex procedure involving extensive bowel manipulation. The ileal conduit is the most commonly used form of UD. While technically less challenging, it is associated with notable complications, including postoperative ileus (POI). In this context, we present a novel robotic stapler technique for performing ileo-ileal anastomosis during robot-assisted radical cystectomy (RARC). Methods: An IRB-approved prospectively maintained cystectomy database was queried for patients undergoing RC or radical cystoprostatectomy between 2020 and 2024. Demographic, perioperative, and complications data are reported using descriptive statistics and compared with the two-tailed Student’s t-test when applicable. We defined POI as a lack of flatus or bowel movement after postoperative day 4. Results: 170 patients underwent the proposed robotic stapler technique, with a median age of 73 years and a BMI of 27.5 kg/m². The majority of UDs performed were ileal conduit (75.8%), followed by neobladder (21%) and continent pouch (2.3%). 7.0% of patients experienced POI, and 4.7% had small bowel obstruction. There were no intraoperative injuries to the bowel. Conclusion: Our described robotic stapler technique for ileo-ileal anastomosis has proven its utility as a method for UD during RARC with relatively low rates of gastrointestinal complications compared to the general literature. This is likely because of multiple components of this technique, including intracorporeal nature, stay sutures, and more.