V09-08: Implementation of Robotic Radical Cystectomy With Intracorporeal Neobladder Reconstruction: Step-by-Step Technique

MARIA SIGHINOLFI*, SIMONE ASSUMMA, ELENA MORINI, MODENA, Italy, ALBERTO DEL NERO, IGOR PIACENTINI, BARBARA MANGIAROTTI, MATTEO MAGGIONI, STEFANO PICOZZI, MILANO, Italy, GIORGIO BOZZINI, COMO, Italy, STEFANO PULIATTI, SALVATORE MICALI, MODENA, Italy, BERNARDO ROCCO, MILANO, Italy

Introduction: RARC with intracorporeal neobladder reconstruction is the most challenging surgical procedure in urology, usually performed in high-volume robotic centers. We present introduction and implementation of the procedure and step by step  surgical tecnique description(video)

Methods: We performed July 15th-Oct 13th 2021 12 RARC. Median age 65 yrs(48-83). 7 RARC for MIBC (4 neoadj CHT). 5 NMIBC with RC criteria. 1 pt had concomitant RARC and robotic rectal excision for rectal adenocarcinoma. 8 pts had intracorporeal neobladder reconstruction 6 males and 2 females included and analyzed,  4 due to medical/oncological contraindications had external diversion. Surgical technique: Patient is placed in 18° Trendelenburg position. Procedure starts with identification and isolation of ureters above iliac vessels til bladder insertion where ureter is closed with M Hem-o-lok and sectioned. In males, peritoneum at seminal vesicle level is incised, a plane between Denonvilliers’ fascia and posterior prostate face is developed (bladder and vagina in females). Lateral bladder aspects are developed bilaterally, vesical pedicles are clipped and transected, neurovascular bundle preservation is performed if indicated. Inverse U peritonectomy is made between internal inguinal rings, umbilical arteries are transected and Retzius space access is created. Anterior space developed, Santorini complex is severed and sutured. Urethra is isolated and incised after L hem-o-lok is placed to prevent spillage. Urethral stump is maintained as possible. Frozen distal ureters and urethra sections were performed then a bilateral extended pelvic nodal dissection. 40-50 cm ileal segment, 20 cm proximal to ileocecal valve, isolation is made with mechanical laparo-stapler and ileal-ileal anastomosis is performed. Median part of isolated segment is pushed towards urethral stump and ileal-urethral anastomosis is performed. Reverse tubular U-segment is configured and detubularized. Neobladder reconstruction starts suturing posterior plane then cranial part is folded downwards to bladder neck in a “heart shaped” orthotopic reservoir, with two lateral horns for direct bilateral ureteral anastomosis

Results: RARC had no intra-op complications. Neobladder pts post-op course was uneventful except 1 peri-anastomotic leakage. No Clavien Dindo 3b, 30days readmission rate was 12.5% (1 febrile UTI)

Conclusions: RARC with neobladder reconstruction surgical technique standardization allows fast procedure implementation with satisfying surgical-clinical outcomes

Source of Funding: .