V408: Intracorporeal Robotic Bladder Augmentation
VideoIntroduction and Objectives
Although most hyper-reflexic, high pressure bladders can be managed with a combination of medications, bladder injections, or neuromodulating implants, bladder augmentation is necessary for some patients to improve compliance and lower storage pressures. A laparoscopic approach may decrease the morbidity of this procedure. We demonstrate our technique for intracorporeal robotic bladder augmentation.
Our index case is an 84 yo man with detrusor overactivity, impaired bladder compliance, and a nonfunctional outlet after seed implantation for prostate cancer and subsequent TURP. Six ports are placed in a fashion similar to a robotic cystectomy and intracorporeal ileal loop. The camera is 22 cm above above the umbilicus, and two robot ports are placed 6 cm apart on the right side. On the left moving medial to lateral from the camera port, there is a 12 mm assistant port, 8 mm robot port, and a 12 mm assistant port just off the anterior/superior iliac spine. The ileum is thoroughly mobilized. A 20cm segment of ileum is selected and divided with a 65 cm battery operated EndoGIA stapling device. Bowel continuity is restored in a side to side fashion using a stapled robotic assisted laparoscopic technique. The augment segment of ileum is opened on its antimesenteric side and oriented in the shape of an inverted U. The two dependent arms of the inverted U are sutured together to create the ileal patch. The dome of the bladder is opened longitudinally, and the bowel patch is anastomosed to the bladder with a single layer of running 2-0 Vicryl suture.
Total robotic time was 398 minutes and total operating room time was 435 minutes. The patient was discharged on postoperative day #5. Videourodynamics demonstrated marked improvement in compliance and capacity two months later.
Intracorporeal robotic ileal cystoplasty is a feasible option for patients requiring bladder augmentation.