Introduction: One of the hardest surgical challenges for robotic surgeon is intracorporeal neobladder reconstruction during robotic radical cystectomy (RARC). In the present video, we illustrate a step-by-step description of the technique and the clinical outcomes from a single center series. Methods: Overall, 40 RARC were performed between July 2021 and October 2022: 20/40 patients underwent intracorporeal neobladder reconstruction and were enrolled in the study. When RARC is completed, a 40-50 cm ileal segment is isolated and the part with adequate mesenteric length is approximated to the urethral stump. A modified posterior reconstruction is conducted. Anastomosis with a barbed suture is finalized. Ileal segments at each side are isolated using robotic staplers and ileal-ileal anastomosis is accomplished. Ileum's reverse tubular U-segment is detubularized to create the neobladder. Posterior plane is first sutured; then, the orhotopic reservoir with two lateral limbs is created. After negative leakage test, a direct uretero-neobladder anastomosis of each spatulated ureter is performed in the dorsal part of the limbs. Ureteral stents are placed and brought out through the abdominal wall. Anterior plate is finally sutured. Results: Mean age was 64.5 years (48-75). Seventeen out of 20 patients were males; 3 were females. One non-surgical intra-operative complication (myocardial infarction requiring an acceleration of operative time) was recorded. During post-op course, two cases of urinary leakage at the neovescical-urethral anastomosis were evident and required prolonged catheterization. Mean length of stay was 17 days (12-27), excluding a single case of prolonged hospitalization due to C. Albicans superinfection. The 30-day readmission rate was 20% (4/20) due to febrile urinary tract infections; 90-day readmission rate was just 5% (1 symptomatic lymphocele requiring percutaneous drainage). Most male patients (14/17) reported daytime continence with insignificant post-voided residual. Between those patients in which nerve-sparing approach was pursued – and have more than 90 days of follow up – 3/5 referred potency. Regarding female patients, incomplete voiding is reported in a case and urinary incontinence (2 pads/day) in another. Conclusions: Intracorporeal neobladder reconstruction is a complex procedure even for expert robotic surgeons. Nevertheless, the standardization of the surgical approach – as displayed in the video – facilitates a rapid implementation of the procedure with positive surgical and clinical outcomes. SOURCE OF Funding: .
