V12-09: Anatomic robot assisted radical cystectomy in female: step by step technique
Robot assisted radical cystectomy in female for bladder cancer is a challenging urologic surgical procedure. We describe step by step surgical technique and present perioperative outcomes of a single patient who underwent a robot assisted radical cystectomy (RARC) with totally intracorporeal orthotopic neobladder (iON).
A 66 yr-old female patient with a cT1/N0/M0 high grade BCG refractory recurrent bladder cancer, underwent RARC and iON.?Key steps of surgery include: the ligation of gonadic pedicles, meticulous dissection of the umbilical and uterine artery and the ureter, dissection of the bladder pedicle, opening of the vagina and creation of the plane between vagina and bladder. Cut of the urethra and securing the Foley catheter with the entire specimen placed into an Endocatch bag to minimize any urine spillage. Removal of the specimen into an endocatch bag through the vagina. Extended pelvic lymph node dissection. Suture of the vagina and creation of a peritoneal flap as posterior neobladder support.
The procedure was successfully completed. Operative time was 295 minutes, EBL was 250 mL, time to flatus was 3 days, time to bowel was 7 days. Hemoglobin and creatinine at discharge were 10.3 g/dL and 0.76 mg/dL, respectively. The hospital stay was 8 days. The pathologic stage was pT0 pN0. The number of nodes removed was 26. Postoperative course was uneventful. The patient recovered daytime continence 45 days after surgery.
A meticulous dissection of vascular suppliers of the bladder, a natural orifice specimen retrieval and the ease of posterior neobladder support thanks to a perfect vision of the small pelvis anatomic structures may contribute to minimize invasiveness and to improve perioperative outcomes of radical cystectomy in female patients.