V11-05: Robot-Assisted Laparoscopic Bladder Diverticulectomy: Surgical Technique and Intermediate Follow Up
VideoIntroductions and Objectives
Bladder diverticula can represent significant morbidity to affected patients. Traditional treatment has involved open surgical excision; however, with the advent and integration of various technologies, this procedure can be preformed via a minimally invasive approach. We report our technique of robot-assisted laparoscopic transperitoneal extravesical diverticulectomy with ureteral reconstruction and report our post-surgical outcomes.
Study Population This is a multi-institutional, IRB approved study. Data was gathered on all patients who underwent robot-assisted laparoscopic bladder diverticulectomy (RALBD) for acquired bladder diverticula between 2003 and 2013 at the University of Toledo and Hackensack University Medical Center. Patient demographic data as well as peri-operative data were collected and analyzed. Surgical Approach All patients were placed in dorsal lithotomy position and had 5 laparoscopic ports placed. Pre-operative imaging, as well as intraoperative cystoscopy, were used to help guide dissection of the diverticulum and identify its neck. The excised diverticulum was removed via an endocatch bag and the bladder repaired in a 2 layer, water tight fashion. One case necessitated ureteral reimplantation and this was carried out via the robotic platform with the stent being placed under direct vision via the cystoscope. All patients were discharged with Foley catheters and placement of a pelvic drain was left up to the individual surgeons.
A total of seven patients were included in the study. The mean age was 63.0 years and mean body mass index was 27.7 kg/m2. Five patients had undergone previous urologic surgery. The mean bladder diverticulum size was 7.9 cm, the mean operating time was 172.1 minutes, and estimated blood loss was 51.4 mL. The mean length of stay was 2 days, the time until Foley catheter removal was 8.4 days. Pre and post-operative American Urologic Association Symptom Score (AUASS) were, 26.8 and 3.5, respectively. No post-operative complications have been encountered with a mean follow up of 12.3 months and a range of 1-37 months.
This study represents the largest reported single cohort examining the efficacy of RALBD for acquired bladder diverticula. This technique represents a viable surgical intervention for symptomatic, acquired bladder diverticula with good outcomes and no post-surgical complications observed during intermediate follow up.