V1886: Robot Assisted Partial Cystectomy for Urothelial Cancer within a Bladder Diverticulum
VideoIntroduction and Objectives
When a bladder diverticulum is present, it is important during the cystoscopic evaluation to directly visualize the diverticulum, as a urothelial carcinoma can be present. In the setting where no other histological evidence of tumor is present elsewhere in the bladder, bladder preservation is a feasible oncological option. We present a case of a 66 year old male with biopsy proven high-grade urothelial carcinoma in a bladder diverticulum, with negative bladder biopsies elsewhere. After options were discussed, a robot assisted partial cystectomy with bladder diverticulectomy was offered to the patient.
Initially, a 5-french open-ended catheter was inserted to identify and delineate the ureter. A camera port, 3 robotic ports and 2 assistant ports were placed. The Space of Retzius was dissected down to the symphysis pubis, exposing the the diverticulum. A flexible cystoscope was then used to help delineate the neck of the diverticulum. Meticulous dissection was performed until the entire diverticulum was mobilized. Purse string sutures were placed on the bladder side next to the neck of the diverticulum to prevent spillage when opening the bladder. The diverticulum was removed in its entirety and immediately placed in a laparoscopic retrieval sac. Bladder was closed in 2 layers.
The patient tolerated the procedure well and was discharged on postoperative day one. Final pathology showed mixed type high-grade urothelial carcinoma, neuroendocrine carcimona, and adenocarcinoma, intestinal like with negative margins.
Minimally invasive robotic bladder preservation surgery is a safe and feasible approach in select patients with bladder carcinoma presenting within a bladder diverticulum. Patients should undergo surveillance cystoscopy post operatively.