V10-13: A Novel Technique of Robotic-Assisted Simple Cystectomy during Robotic-Assisted Urinary Diversion for Benign Indications
VideoIntroductions and Objectives
When urinary diversion is necessary for benign indications, it has often been recommended that simple cystectomy be performed simultaneously, to avoid the complications of bleeding, pain, pyocystis and secondary urothelial carcinoma. These complications occur in 54-80% of patients left with a native bladder after diversion, and completion cystectomy is performed in 20 to 25% of patients._x000D_ _x000D_ These complications may be avoided by performance of simple cystectomy at the time of urinary diversion. This operation has been described only via open approach._x000D_ _x000D_ We present here a technique of successful robotic-assisted simple cystectomy performed at the time of urinary diversion.
This patient is a 46yo female who was scheduled for robotic– assisted hysterectomy, end colostomy and urinary diversion for the urologic indications of pain and intractable fecal and urinary incontinence. She had experienced severe infectious complications in the setting of previous spinal injury and an extensive smoking history. _x000D_ _x000D_ The patient underwent planned robotic – assisted hysterectomy for separate gynecological indications via a separate team at the same setting._x000D_ _x000D_ The colon was mobilized and transected to produce adequate length for end colostomy, as well as appropriate distal sigmoid colon for urinary diversion without re-anastomosis. _x000D_ _x000D_ Robotic ureteral dissection and stented uretero-intestinal anastomoses were performed with the sigmoid conduit in an isoperistaltic orientation._x000D_ _x000D_ Once this was successfully completed, simple cystectomy was performed as follows:_x000D_ 1. The bladder was dissected free from surrounding peritoneal attachments._x000D_ 2. A midline incision was utilized to bivalve the bladder._x000D_ 3. The submucosal plane was identified and simple cystectomy executed._x000D_ 4. All resected mucosa and suprapubic tract is carefully removed in a specimen bag and sent for pathologic analysis._x000D_ 5. The ostomies were matured and port sites closed.
Surgical time for simple cystectomy was 48 minutes. Estimated blood loss for this portion of the procedure was unquantifiable, but was considered to be under 10 mL as essentially no bleeding was encountered. The patient was discharged without complication.
Robotic-assisted simple cystectomy is expedient and recapitulates the principles of the open procedure. Decreases in surgical time would be anticipated as experience increases. Larger series and long-term follow-up is required.