V8-02: Management Of Challenging Urethro-Ileal Anastomosis During Robotic Intracorporeal Neobladder Formation
VideoIntroductions and Objectives
There has been an increase in the performance of robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion in recent years. RARC with intracorporeal neobladder formation has been demonstrated to be a feasible and reproducible technique. In this video we aim to demonstrate maneuvers that can aid in overcoming difficulties faced during the formation of challenging urethro-ileal anastomoses during RARC with intracorporeal neobladder.
The current study is an analysis of recorded videos of RARC with intracorporeal neobladder performed at our institution with attention to challenges faced during completion of the urethro-ileal anastomosis. Maneuvers facilitating creation of the urethro-ileal anastomosis are introduced and demonstrated in a stepwise fashion. Maximal preservation of urethral length at the time cystoprostatectomy, complete removal of sigmoid colon from the pelvic cavity prior to anastomosis, appropriate bowel segment selection, reducing pneumoperitoneum, taking the patient out of steep Trendelenburg position, utilizing barbed sutures for the anastomosis, and detubularization of bowel loop prior to urethro-ileal anastomosis are demonstrated in this video.
We outline strategies for preventing difficulties with urethro-ileal anastomosis during RARC with intracorporeal neobladder. Furthermore we offer some key technical points that can be beneficial in overcoming challenges faced in creating the urethro-ileal anastomosis.
Due to the technically complex nature of RARC with intracorporeal neobladder, awareness of potential pitfalls during each step of the process is essential. Challenges faced and the solutions discussed in this video provide a valuable resource for clinicians performing this procedure.