Advancements in robotic systems have made augmentation cystoplasty more accessible, despite its complexity and potential complications. We aim to compare perioperative outcomes of our early experience with extracorporeal and intracorporeal approaches for small bowel harvesting in robotic augmentation cystoplasty.

From November 2021 to July 2024, we performed 10 robotic augmentation cystoplasties (6 extracorporeal, 4 intracorporeal). All procedures were performed using a da Vinci Surgical System in a four-arm configuration. The technique involved supratrigonal cystectomy, harvesting a 40cm bowel segment, and detubularizing it to form a W-shaped configuration. In the intracorporeal approach, all steps, including bowel harvesting and anastomosis, were performed robotically. Perioperative outcomes were compared between the two approaches.

Baseline characteristics are presented in Table 1. Two extracorporeal cases were excluded from perioperative analysis due to open conversion (right ureteral injury) and concomitant left nephrectomy. As shown in Table 2, median operative time was similar between intracorporeal (341.5 minutes) and extracorporeal (372.0 minutes) approaches. Estimated blood loss (200mL for both) and length of hospitalization (17.5 vs 18.5 days) were comparable. Bowel function recovery was faster in the intracorporeal group (2.0 vs 3.5 days). Postoperative pain scores were slightly higher in the intracorporeal group at 24h and 48h, but similar at 7 days. Complications occurred in 1/4 intracorporeal (25%) and 4/6 extracorporeal (66.7%) cases. The intracorporeal complication (urine leakage) required percutaneous drainage (Clavien-Dindo III). Two extracorporeal patients experienced ileus, managed conservatively (Clavien-Dindo II). Postoperative bladder capacity increased in both groups (intracorporeal: 195.0 to 330.0mL; extracorporeal: 142.5 to 375.0mL).

Our early experience suggests that totally intracorporeal robotic augmentation cystoplasty is feasible and safe, with perioperative outcomes comparable to the extracorporeal approach. Potential benefits include faster bowel function recovery, although longer-term follow-up and larger studies are needed to confirm these findings.