V1891: Intracorporeal ileal conduit urinary diversion
VideoIntroduction and Objectives
To date, centers performing robot-assisted cystoprostatectomy predominantly complete the urinary diversion extracorporally. Reports of intracorporeal ileal conduit are limited to small case series with short follow-up; nevertheless intracorporeal conduit creation has several theoretical benefits, which makes it an attractive technique for further exploration. Decreased ureteral length may reduce the risk of stricture due to ischemia. Moreover, cosmesis might be better particularly in females, where vaginal organ extraction is possible. Smaller incision length may also reduce postoperative pain burden.
In this video, we demonstrate our technique for robot-assisted intracorporeal ileal conduit formation. Key points discussed include port placement, ureteral dissection, conduit isolation, enteric anastomosis, abdominal wall suspension of the ureters and ureteral-enteric anastomosis. While commonly performed after robot-assisted cystoprostatectomy, our index case is a 79 y/o patient who elected to undergo urinary diversion for intractable incontinence following salvage prostatectomy.
Operative time was 2 hours and 47 minutes. Estimated blood loss was 50 mL. Diet was started on postoperative day 2. Drain was removed on postoperative day 3. He was discharged on postoperative day 4 with an uneventful hospital and postoperative course at a follow-up of 5 months.
We demonstrate the safety and feasibility of robot assisted ileal conduit formation with a focus on several key points important for operative success. Long-term functional outcomes will further define the role of this procedure.