Introduction: Robotic cystectomy is associated with low utilization rates of orthotopic neobladder reconstruction due to challenges related to intracorporeal sewing and configuration. A new technique that shortens the learning curve may lead to greater utilization of neobladders and improve outcomes. In this video, we present a new technique for single incision robotic cystectomy (SIRC) with orthotopic Studer-type ileal neobladder using the da Vinci Single Port (SP) robotic platform. Methods: A single 5 cm periumbilical incision is utilized to perform a robotic cystectomy in standard fashion, preserving neurovascular bundles when indicated. The robot is undocked, the specimen is removed and the Studer neobladder is constructed extracorporeally through the 5 cm incision. Enterotomies are made for the urethral and ureteral anastomoses, with pre-placement of anastomotic sutures to facilitate intracorporeal anastomosis. The neobladder is returned to the abdomen, the robot is redocked and the anastomoses are completed intracorporeally. Results: Forty-one patients have undergone SIRC, with 50% of these patients undergoing orthotopic neobladder reconstruction. Seventeen (41%) of all single-port cases were converted to open. The median operative time was 480 minutes and the median length of hospitalization was seven days. 17% required readmission to the hospital, 17% developed small bowel obstruction or ileus, and 13% required a blood transfusion. There were no differences noted in pain (morphine milligram equivalents) between the patients who underwent SIRC and those that were converted to open. Conclusions: SIRC with orthotopic neobladder reconstruction using the da Vinci Single Port (SP) robotic platform is a safe and feasible minimally invasive approach. With this hybrid intracorporeal/extracorporeal technique, incisional burden is limited to what would otherwise be required for extraction while simultaneously adhering to long-standing principles of neobladder reconstruction. SOURCE OF Funding: None
