V05-06: Robot-assisted laparoscopic revision of ileal conduit: Description of surgical technique
Ileal conduit is considered a safe procedure and the gold standard surgery for urinary diversion following cystectomy. Stomal and conduit related complications including parastomal hernia, stomal stenosis, anastomotic stricture, and conduit stricture have been extensively discussed in the literature. Conservative management including balloon dilation is usually the initial management approach. However, in severe cases revision of the ileal conduit is inevitable. In this video, we present the surgical technique for robot-assisted laparoscopic revision/recreation of ileal conduit in a patient with parastomal hernia, severe stomal stenosis, and conduit stricture.
A daVinci Xi-system with 4 robotic arms (8 mm trocars) and one 12 mm assistant port was used. Patient was placed in lithotomy and modified Trendelenburg position and robot was docked between the legs. Key steps of the surgery include: meticulous dissection of the bilateral ureters to free them up from the previous conduit remnant, excision of the previous bowel anastomosis site, preparation of a new ileal loop for creation of a new conduit, ureteroileal anastomosis, reestablishment of the bowel continuity, repair of the parastomal hernia, and creation of a new stoma.
The length of the surgery was 3.5 hours with 150 cc of estimated blood loss. Postoperative recovery was smooth without any complication. Bowel function returned on postoperative day 3 and patient was discharged on postoperative day 5. Follow-up CT scan 3 months after surgery showed significant improvement of the hydronephrosis and resolution of the parastomal hernia at the previous stoma site with patent new conduit in the left lower quadrant.
Robot-assisted laparoscopic revision/recreation of the ileal conduit is a feasible option in patients with severe stomal stenosis and conduit stricture. It is an alternative for currently used open surgical techniques with potential for faster recovery and shorter hospital stay. Prospective trials are warranted to evaluate the outcomes of this technique in larger patients population.