{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:50:14Z","timestamp":1779195014714,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019400","name":"ConMed","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019400","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJUI Compass"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Robotic cystectomy is the mainstay surgical intervention for treatment\u2010refractory nonmuscle\u2010invasive and muscle\u2010invasive bladder cancer. However, paralytic ileus may complicate the postoperative recovery and may be a consequence of an inflammatory response associated with transient gut ischaemia. We have therefore investigated clinical, operative and inflammatory biomarker associations between paralytic ileus in the context of robotic cystectomy and intracorporeal ileal conduit urinary diversion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective consective patients referred for robotic cystectomy were consented and included in the study, while patients &gt;75\u2009years old and converted to open procedure were excluded. The pneumoperitoneum pressure (PP) for carbon dioxide insufflation required to perform the procedure efficiently and safely was recorded (12 or 15\u2009mmHg). We also recorded the postoperative days patients passed flatus and stools, whether they developed ileus, as well as other standard clinical and demographic data. The expression of select proinflammatory and anti\u2010inflammatory cytokines was determined by multiplex analysis using a cytometric bead array with changes in profiles correlated with the pressures applied and with the existence of an ileus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010seven patients were recruited, but only 20 were used in the study with 10 patients in each PP group. Seven patients were excluded all of whom had an extracorporeal ileal conduit formation. There were differences in the 40\u2010min shorter operative time and 1\u00a0day shorter length of stay, as well as passing flatus 1\u00a0day and stools 1.5\u00a0days earlier in the 12\u2009mmHg compared with the 15\u2009mmHg group. More patients had ileus in the 15\u2009mmHg group vs 12 mmHg group (30% vs. 10.0%). These were not statistically significant. Similarly, there were no statistical differences in the expression of proinflammatory cytokines at the two different pressures or between patient groups, but there were outliers, with the median indicating nonsymmetrical distribution. By comparison, anti\u2010inflammatory cytokines showed some significant differences between groups, with IL\u20106 and IL\u201010 showing elevated levels postsurgery. No statistical difference was observed between pressures or the existence of an ileus, but the maximum levels of IL\u20106 and IL\u201010 detected in some patients reflect a pressure difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The initial findings of this novel scientific study indicated a higher risk of paralytic ileus postrobotic cystectomy and robotic intracorporeal urinary diversion when a higher pressure of 15\u2009mmHg is used compared with 12\u2009mmHg. Although further studies are required to establish the linkage between cytokine profile expression, pressure and ileus, our initial data reinforces the advantages of lower pressure robotic cystectomy and intracorporeal urinary diversion in patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bco2.240","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T09:28:54Z","timestamp":1681205334000},"page":"575-583","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparing different pneumoperitoneum (12 vs. 15\u2009mmHg) pressures with cytokine analysis to evaluate clinical outcomes in patients undergoing robotic\u2010assisted laparoscopic radical cystectomy and intracorporeal robotic urinary diversion"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3966-5734","authenticated-orcid":false,"given":"Nikhil","family":"Vasdev","sequence":"first","affiliation":[{"name":"Department of Urology, Lister Hospital East and North Hertfordshire NHS Trust  Stevenage UK"},{"name":"School of Life and Medical Sciences University of Hertfordshire  Hatfield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Martin","sequence":"additional","affiliation":[{"name":"Faulty of Health and Life Sciences De Montfort University  Leicester UK"},{"name":"Department of Respiratory Sciences University of Leicester  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amon B.","family":"Hackney","sequence":"additional","affiliation":[{"name":"Department of Respiratory Sciences University of Leicester  Leicester 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