Introduction: In this video, we detail the steps of a robotic prostate-sparing cystectomy. We spend a significant portion of the video showing the posterior dissection, which is unique to this procedure. During this dissection, a plane is developed between the bladder and the seminal vesicles until the bladder neck is reached.
Methods: This video is an edited version of a procedure performed on a patient with muscle-invasive urothelial cancer of the bladder. A TURP and prostate MRI confirmed that there was no invasion of the prostate. He had no other contraindications to continent diversion. The steps of the procedure are as follows: identification and dissection of bilateral ureters, posterior dissection, division of the ureters, anterior dissection, bladder neck dissection, simple prostatectomy, bilateral pelvic lymph node dissection, harvesting of the neobladder and bowel anastomosis, neobladder anastomosis, neobladder sculpting, ureteral anastomosis. This video specifically highlights the posterior dissection, bladder neck dissection, and neobladder anastomosis. The posterior dissection is unique to this procedure, because we create a plane between the bladder and the seminal vesicles and preserve the pelvic floor. There is also an opportunity during this procedure to spare the vas deferens and preserve fertility.
Results: We have performed this procedure on five patients at this institution. All five patients are continent. Two of these patients are hyper-continent, but improving with pelvic floor physical therapy.
Conclusions: Robotic prostate-sparing cystectomy with neobladder is an option for well-selected patients who desire continent diversion or continued fertility. It provides a unique plane of dissection between the seminal vesicles and bladder.
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