V10-11: Robotic Cystectomy with Anterior Pelvic Exenteration: A Simplified Step-by-Step Approach

Video

Introductions and Objectives
Robotic cystectomy with anterior pelvic exenteration (RCAPE) is feasible and is a minimally invasive approach for managing bladder cancer in females requiring cystectomy. We describe a simplified, standardized technique that removes many technical limitations while adhering to all oncologic principles.

Methods
Ports are placed in the standard cystectomy fashion as previously described in the “W” configuration with a 12 mm assistant port on the right side of the patient. The patient is placed in the steep Trendelenberg position and the robot is docked. The ureters are dissected followed by posterior dissection with assistance of a malleable retractor in the vagina. Lateral dissection is performed to develop the pedicles and vaginal walls which are then secured using the Caiman© Tissue Sealing Device (Aesculap, Center Valley PA). Finally, the dorsal venous complex and urethra are divided. We routinely perform intracorporeal ileal conduit urinary diversion according to our described technique.

Results
Between August 2011 and October 2013 we have performed 25 RCAPE using this standardized technique. Operative time including pelvic exenteration, vaginal closure, bilateral extended pelvic node dissection and intracorporeal ileal conduit urinary diversion was an average of 355 minutes and estimated blood loss was an average of 347 mL. One patient required a blood transfusion and length of hospital stay was an average of 6 days. Finally, complications were assessed according to the Memorial-Sloan Kettering Grading System and 3 patients had minor (grades 1-2) complications and 2 patients experienced major (grades 3-5) complications.

Conclusions
Robotic cystectomy with anterior pelvic exenteration can be performed using our simplified technique safely with minimal difficulty. Our technique is reproducible with excellent oncologic outcomes and allows for rapid progression to intracorporeal urinary diversion if desired.

Funding: None