Evaluation of robot-assisted laparoscopic versus open cystectomy and effect of carbon dioxide-pneumoperitoneum on histopathological findings in ureteroenteric anastomoses: results from an experimental randomized porcine study

Abstract

Objective: The aim of this study was to investigate the histopathology of ureteroenteric anastomoses (UEAs) after radical cystectomy (RC) with an ileal conduit in a porcine model using different surgical techniques. The study also evaluated the potential anti-inflammatory effect of preoperative carbon dioxide-pneumoperitoneum (CO₂P).

Materials and methods: Forty female Danish Landrace pigs were randomized to four groups: three intervention groups [open surgery ± prior CO₂P and robot-assisted laparoscopic cystectomy (RALC)], all subjected to RC and an ileal conduit, and one control group. After euthanization, UEAs were harvested and histopathologically evaluated.

Results: Five pigs were excluded from the study owing to postoperative complications. Operating room time and clamping of the right and left ureters were significantly longer in the robotic than in the open groups (p < .01). Inflammatory infiltration grade of the left ureter was significantly higher in RALC (p = .032). No statistically significant difference was observed between the open groups receiving prior CO₂P or not.

Conclusions: Results showed a statistically significant higher inflammatory infiltration grade of the left ureter in RALC, emphasizing the importance of using meticulous techniques when mobilizing the left ureter using the robot. It was not possible to conclude with certainty whether CO₂P could constitute an anti-inflammatory agent for local inflammation.

Keywords:

• Comparative study
• cystectomy
• disease model animal
• minimally invasive surgical procedure
• pathology

Acknowledgements

The skilled assistance of nurse Lene Foss; the authors’ PhD colleagues: Lotte Kaasgaard Jakobsen MD, Maria Elkjær Carlsen MD; and medical students: Lasse Nonbo, Malene Astrup, Andreas Chatterton, Mette Vinther Riber, Camilla Grøndahl, Emilie Winther and Kira Thorssteinsson; and for technical support laboratory technicians: Gitte Kall Bjerggaard (Department of Clinical Medicine), medical student Maiken Rasmussen and Tommy K. Nielsen MD (Department of Urology, Aarhus University Hospital) and Kira Sonnichsen-Graahede (animal caretaker) and Henrik Sørensen (Department of Clinical Medicine, Aarhus University Hospital) is gratefully acknowledged.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The study received funding from the University of Aarhus Research Foundation, Agnes Niebuhr Jensen Foundation, Minimal Invasive Development Center (MIUC), Karen Elise Jensen’s Foundation, M.L. Jørgensen and Gunnar Hansen’s Foundation, and A.P. Møller and wife Chastine Mc-Kinney Møller’s Foundation.