V1-09: Robotic Radical Cystectomy with Intra-corporeal Neobladder Urinary Diversion
Robotic radical cystectomy for management of bladder cancer is gaining traction as an alternative to the open approach although there is no proven benefit as of yet. Furthermore, some centers are performing the urinary diversion robotically in the case of a conduit and there is growing experience with performing neobladders robotically as well. In this video we demonstrate our single institution technique and early experience with intra-corporeal neobladder urinary diversion following robotic radical cystectomy.
We demonstrate the following steps of robotic intra-corporeal neobladder urinary diversion: 1) Isolation and division of the small bowel, 2) small bowel anastomosis, 3) bowel detubularization, 4) creation of the posterior plate, 5) rotation of the pouch and urethral anastomosis, 6) closure of the anterior wall of the neobladder, 7) uretero-ileal anastomosis and stent placement. We reviewed total operative time (skin to skin) for our first 9 consecutive patients undergoing robotic radical cystectomy, extended lymph node dissection, and intra-corporeal urinary diversion from 9/2014 to 9/2015.
Reviewing our first 9 patients shows a significant decrease in overall operative during this early learning curve. Figure 1 demonstrates total operative time (skin to skin) for robotic radical cystectomy, extended lymph node dissection, and intra-corporeal urinary diversion for our first 9 consecutive patients.
Robotic intra-corporeal neobladder urinary diversion is safe and feasible. The principles of the open approach are maintained with no shortcuts being taken. The initial learning curve is step but surmountable. Continued refinement of the technique and a team approach are crucial to decrease operative time and reproducibility.