V2-12: Robot-Assisted Intracorporeal Ileal Neobladder: Simplified Step-By-Step Technique And Surgical Outcomes

Video

Introductions and Objectives
To detail our simplified technique for robotic intracorporeal ileal neobladder (NB) after robot assisted radical cystectomy (RARC).

Methods
Between January 2012 and July 2013, 12 consecutive RARC with intracorporeal NB were performed. A transperitoneal five-port approach using a 4-arm da Vinci® robot (Intuitive Surgical, Sunnyvale, CA, USA) and one patient-side assistant was employed. Outcomes as well as surgical technique are reported. The enclosed video details the steps of the procedure including the bowel segment selection and anastomosis, the ileourethral anastomosis, the detubularization and neobladder reconstruction, and finally the ureteroileal anastomoses.

Results
All procedures were successfully completed. Main surgical parameters were as follows: average operative time 442±57 min, estimated blood loss 420±213 ml, and hospital stay 8.4±2.8 days. Complications occurred in 66.6% of the cases of which, 58.3 % were postoperative with 41.6% and 16.7% of the patients experiencing minor (grade 1-2) and major (grade 3-5) complications respectively. Readmission and secondary procedure were 25% and 16.7% respectively.

Conclusions
Robotic intracorporeal NB represents a challenging surgical task. A simplified step-by-step approach allows a practical standardization of the procedure and ultimately facilitates its safe implementation.

Funding: None