Comparison of the EndoGIA versus the Endowrist stapler in intracorporeal urinary diversion in robotic assisted radical cystectomy (EGIAES) - a randomized multicentre trial.

Despite increased surgical experience, improved perioperative care and technological advancements, postoperative ileus (POI) continuous to be a common complication following cystectomy with urinary diversion. In theory, POI can be reduced if lumen of the enteric anastomosis performed during surgery has the sufficient diameter. We aimed to evaluate different stapler types on bowel function recovery, comparing two firings of the robotic Endowrist 45 mm (EW45) stapler with the handheld EndoGia 60 mm (EG60). We hypothesized that better robotic maneuverability and a longer stapler length would create a wider anastomosis and thereby improve postoperative bowel function. This multicentre RCT was conducted between 2018 and 2021 (NCT03385798). Seventy-eight patients with bladder cancer undergoing radical cystectomy with ileal conduit were randomized 1:1 (EW45 or EG60). Time to first flatus and bowel movement was registered postoperatively and patients were followed up with the validated Bowel Function Index (BFI) preoperatively, at 3 weeks, 4 and 12 months postoperatively. The EW45 group had a higher POI rate (24% vs. 3%), longer time to first flatus (93 h vs. 71 h, p = 0.004), and longer length of hospital stay (LOS) (13 vs. 8 days, p = 0.001). No significant differences were observed in readmission, reoperation, or mortality. BFI scores did not differ between groups at any time point. Patients operated with EW45 had higher rates of POI and LOS, indicating worse outcome in the perioperative phase. However, no differences in long-term bowel function were observed and both techniques had the same risk of reoperation and mortality.