V8-11: Robotic Intracorporeal Ileal Conduit: Focusing on the Bedside Assistant
Robotic radical cystectomy is being adopted more widely with increased training in the technique and availability of the robotic platform. In this video we present variations in port placement for robotic radical cystectomy and intracorporeal ileal conduit diversion, focusing on techniques for the bedside assistant.
At our center, robotic radical cystectomy is performed with port placement similar to robotic radical prostatectomy, with the ports placed 3-4 cm higher on the abdominal wall to assist with bowel harvesting. The patient in positioned in dorsal lithotomy. The 12 mm assistant port is placed on the right side of the patient. This port may be used for introduction of the stapler for harvesting of the ileal conduit. Alternatively, an accessory 12 mm port may be placed in the suprapubic area to facilitate bowel harvesting. A bedside assistant with laparoscopic skills is beneficial to optimize operative time and outcomes. A 45 mm endoscopic stapler is used with performing bowel harvesting via a 12 mm suprapubic port, while a 60 mm stapler alternatively, may be used via the 12 mm right-sided assistant port.
Success of performing robotic-assisted radical cystectomy and intracorporeal ileal conduit diversion is highly dependent on an experienced surgical team and a bedside assistant skilled in laparoscopic techniques and familiar with stapler handling. Proficiencies with stapler angling and stabilization during firing will allow harvesting of the bowel to be performed in the safest manner possible. Endoscopic introduction of the stapler can be performed via the assistant port or from a 12 mm port placed in a suprapubic position.
Robotic radical cystectomy with intracorporeal ileal conduit for surgical management of bladder cancer is becoming more popular at high volume centers. Success for performing these procedures on a routine basis necessitates bedside assistants proficient in laparoscopic and who are knowledgeable with regard to stapler handling and mechanics.