Introduction: Radical cystectomy remains the gold-standard treatment of muscle-invasive bladder cancer. Nerve sparing approaches have been performed and described over the past decades. The advent of robotic approaches with superior vision and magnification, has allowed enhanced techniques of nerve sparing during radical cystectomy. We hereby illustrate the main anatomical landmarks and the use of hydrodissection for neurovascular bundle preservation during robotic assisted radical cystectomy. Methods: In this video, we highlight the operative steps during radical cystectomy, to achieve neurovascular bundle preservation. We describe the technique of using Endo GIA to release the bladder pedicle as well as the use of saline needle hydrodissection to facilitate the dissection of the neurovascular bundle away from the prostate pedicle. We also describe the use of the Endo GIA stapler to divide the prostate pedicle, while minimizing the traction on the cavernosal nerves. Results: We compiled the important operative steps as well as the essential anatomical landmarks that have been previously described to perform neurovascular bundle sparing during radical cystectomy. We further attempt to refine the technique of nerve sparing utilizing the advantage of magnification and superior functionality of robotic surgery. Conclusions: Robotic surgery has allowed improved vision and understanding of complex pelvic anatomy. This has made way for enhanced surgical technique for neurovascular preservation during radical cystectomy. SOURCE OF Funding: Roswell Park Alliance Foundation
