V1885: ROBOTIC ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION USING A MODIFIED PFANNENSTIEL INCISION

Video

Introduction and Objectives
Robotic assisted laparoscopic radical cystectomy (RARC) is gaining popularity. A completely intracorporeal procedure is technically difficult and time consuming procedure. Most surgeons perform the diversion using small midline incision, which is also used for specimen retrieval. We report our technique of RARC with modified Pfannenstiel incision.

Methods
Cystectomy is performed using da Vinci robotic platform in a standard fashion. Bilateral pelvic lymph node dissection (BPLND) is done and the robot is undocked; 8-10 cm transverse curvilinear incision is made along pubic hairline centered over symphysis pubis. V-shaped incision (limbs of V at 30° angle, prevents inadvertent entry into inguinal canal) is made in the anterior rectus sheath with midpoint 2 cm above symphysis pubis. Rectus sheath is reflected and V-incision is converted into Y-incision by vertical incision on the inferior leaflet of rectus sheath towards pubic symphysis. Rectus muscles are separated. Specimen is extracted, neobladder (NB) / ileal conduit (IC) is performed and diversion completed via the incision

Results
30 patients underwent RARC since April 2008. Median age was 65 yr (44-85). All had extracorporeal urinary diversions. Ratio of IC vs. NB was 6.5:3.5. The EBL was 275 (175-375ml), mean operating time was 5±0.8 hr. No intraoperative visceral injuries were noted. Two patients had positive surgical margins. Mean number of lymph nodes removed was 12±3. No incision hernia noted.

Conclusions
RARC with modified Pfannenstiel incision is feasible, less time consuming, facilitates NB/IC reconstruction . The incision heals with a cosmetic scar and low risk of Incisional hernia.

Funding: None