Technique of extracorporeal urinary diversion

The purpose of this chapter is to provide a step-by-step approach to the different extracorporeal urinary diversions that may be performed in the setting of robotic-assisted laparoscopic radical cystectomy (RARC). Recent reports indicate comparable results to open surgery with regard to intermediate-term oncological outcomes and extent of pelvic lymph node dissection. However, operative times are one of the main obstacles that hinder widespread acceptance of RARC. Extracorporeal urinary diversion with RARC provides a method of reconstruction that mirrors that of open surgery with regard to operative times. Complication rates and functional outcomes with extracorporeal urinary diversion also appear comparable to open series. We will discuss in detail the extracorporeal techniques of a Studer orthotopic neobladder, Indiana pouch continent cutaneous urinary diversion, and ileal conduit urinary diversion. At our institution, we have performed more than 250 RARCs. All urinary diversions were performed extracorporeally and the majority were continent urinary diversions. We describe our technique that follows a common template, which can be applied to all types of urinary diversion.