Robotic cystectomy: Y-shaped neobladder technique

Author(s):

This video demonstrates a technique for the intracorporeal creation of a robot-assisted Y-shaped neobladder after cystectomy.

Jonathan N. Warner, 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 technique for the intracorporeal creation of a robot-assisted Y-shaped neobladder after cystectomy.

Dr. Dechet: Dr. Warner's video nicely demonstrates a robotic Y-neobladder. An advantage of this neobladder is that it is easily conceptualized.

Key points are illustrated in this video. The urethral anastomosis is performed first and in the most dependent portion of the ileum. The video also demonstrates the addition of vicryl sutures to support the urethral anastomosis anteriorly, which may be helpful in taking tension off the anastomosis while the neobladder is subsequently being configured.

The video also shows a very elegant way to perform the ureteral anastomoses. A clear advantage to the Y-neobladder is that the left ureter does not need to be tunneled under the sigmoid colon. A nice trick is demonstrated with the placement of the ureteral stents through a Foley catheter whose end has been removed. The stents are easily guided into their respective ureters after first sewing only the lateral aspect of the ureteral-neobladder anastomoses. Once the stents are in place, the anastomoses are completed and the remaining portion of the anterior wall of the neobladder is closed.

Dr. Hotaling: Dr. Warner’s video nicely demonstrates the advantages of performing the urethral anastomosis first to take tension off the neobladder. The Y-neobladder configuration is also advantageous in that the left ureter does not need to be tunneled under the colon, further reducing the tension. Throughout the video, meticulous tissue handling in a well-developed, nearly bloodless tissue plane make identification of the relevant anatomic structures very obvious.