To explore the clinical efficacy of robotic-assisted laparoscopic radical cystectomy (RARC) with totally intracorporeal orthotopic U-shaped ileal neobladder by Da Vinci Xi surgical system. Furthermore, the effect of this procedure on urination and possible mechanism was evaluated based on postoperative urodynamic analysis.

A group of 8 consecutive patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal orthotopic U-shaped ileal neobladder surgery from June 2020 to March 2021 was enrolled in the study, including 7 males and 1 female and the age was 63(18) years. One case was with very high risk non-muscle invasive bladder cancer (NMIBC), and 7 cases were with muscle invasive bladder cancer (MIBC). The postoperative follow-up time was 3-12 months. The patients' urinary control recovery, renal function, changes in the imaging structure of the upper urinary tract, and oncology prognosis during the follow-up period were recorded.

All the procedures were completed successfully. The complication rate was 37.5%. Seven cases (87.5%) had complete urinary control during the day and 6 cases (75.0%) had functional urinary control at night 3 months after operation. Urodynamic examination at 6 months after operation showed that the maximum urine flow rate and average urine flow rate were 19.8(3.97) ml/sand 5.05(0.94) ml/s respectively. The maximum urethral pressure were 81.5(28.75) cm H₂O and neobladder compliance were 26.5(12.75) ml/cm H₂O.

Robotic-assisted laparoscopic radical cystectomy (RARC) with totally intracorporeal orthotopic U-shaped ileal neobladder is available with a good reproducibility. It is a new bladder replacement with good effect and ideal urinary control recovery after radical cystectomy.