V10-05: Robot assisted bladder augmentation and bilateral ureteral reimplantation
VideoIntroductions and Objectives
With the advent of minimally invasive procedures, robotic surgery seeks to match the same results of open surgery, reducing morbidity due to less blood loss and faster postoperative recovery, minimizing the number of complications. The purpose of this video is to show the feasibility of performing a robot assisted bladder augmentation in a woman with contracted end stage bladder and to compare pre and post-operative images of this patient.
A 64-year-old Caucasian woman presented with a history of cervical cancer treated in 2009 with radiotherapy and chemotherapy. The patient consults the department of urology in 2013 with bilateral hydronephrosis secondary to distal obstruction of both ureters and an end stage small capacity bladder, requiring bilateral ureteral stent and placement of a Foley catheter. Cystography showed a bladder with a capacity of less than 50cc with the presence of bilateral reflux. The patient was free of oncological disease 54 months after she finished radiotherapy and once she recovered from treatment, we suggested an orthotropic intracorporeal robot-assisted ileal augmentation with resection of the distal ureters and reimplantation. A transperitoneal technique was performed with 6 ports (similar to radical cystectomy) with a 4 arm Da Vinci platform (intuitive surgical).
Identification of both ureters at the level of the iliac vessels was performed; distal sectioning 1 cm cephalad to the stenotic area was identified. The bladder was bi-valved and opened. Forty-five cms of terminal ileum were isolated at 20 cm from the ileocecal valve and subsequent side-to-side anastomosis with ENDO GIA 60-mm was done. We detubulized 30 cm distal from the isolated segment, leaving 15 cm of proximal ileum for the making of the chimney where both ureters were anastomosed. The detubulized ileal segment was attached to the edges of the remanant bladder and the closure of the rest of the intracorporal augmentation was done with V- Loc absorbable barbed suture (Glycolide, dioxanone and trimethylene carbonate). The patient had a fast postoperative recovery and was discharged on the eighth postoperative day. Ureteral catheters and Foley catheter were removed after 21 days. Follow up at 6 months showed complete continence without ureteral catheters and appropriate images of the upper urinary tree.
The robot assisted ileal bladder augmentation is feasible, offering the advantages of mini-invasive techniques. More cases will be needed to validate their application.