Robotic cystectomy: Intracorporeal neobladder using Studer technique

Author(s):

This video demonstrates a robotic neobladder technique using the University of Southern California approach, which applies a number of open surgical techniques.

Michael Santomauro, MD

Commentary by Christopher B. Dechet, MD

Section Editor’s note: ‘Y’tube, a video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference.In this installment, Drs. Santomauro, Warner, and Dechet describe robot-assisted cystectomy and urinary diversion. The surgeons demonstrate the importance of clear visual identification of relevant structures, use of colored sutures to help reconstruction, novel use of a V-lock suture in bowel reconstruction, and excellent recreation of open surgical techniques using a minimally invasive approach. As robotic and oncologic surgeons continue to push the limits of what can be done robotically, these videos will serve as an important reference for other surgeons.

This video demonstrates a robotic neobladder technique using the University of Southern California approach, which applies a number of open surgical techniques.

Dr. Dechet: Dr. Santomauro's video nicely demonstrates a robotic intracorporeal neobladder using a Studer-like technique. Various important steps are illustrated.

The neobladder is accomplished prior to the urethral anastomosis. The use of a Rocco-type stitch helps identify and place the most dependent portion of the ileum in the pelvis. A method of measuring the length of the ileum necessary for the creation of the neobladder is described, which can avoid confusion when trying to create the neobladder.

Prior to the bowel anastomosis, an additional 5-cm segment of bowel is resected to provide appropriate space between bowel and neobladder. The use of a chest tube to facilitate the bowel detubularization and excellent use of an assistant to sew the posterior plate are illustrated. Finally, the urethral anastomosis is sewn prior to completing the anterior portion of the neobladder. All these steps greatly facilitate completion of this difficult surgery in a timely manner.

Dr. Hotaling: This video demonstrates novel uses of a V-lock suture, use of a chest tube, and a hematuria catheter to aid in a time-efficient and reproducible neobladder. Dr. Santomauro also makes excellent use of colored sutures to clearly mark the bowel segments necessary for reconstruction and avoid confusion. He also applies many of the techniques of open surgery to facilitate robotic intracorporeal suturing and demonstrates the importance of thorough visualization and exposure.