Robot-Assisted Modified Vescica Ileale Padovana Neobladder: A Novel and Simple Technique for Robotic Intracorporeal Bladder Replacement Reproducing Open Surgical Principles

Abstract

Introduction and Objective: Vescica Ileale Padovana (VIP) pouch has gained popularity because of its technical simplicity and good outcomes. We intended to replicate the open technique robotically in case of nonmetastatic muscle-invasive carcinoma bladder as described by Cacciamani et al.1 Methods: A 53-year-old man underwent robotic radical cystoprostatectomy with pelvic lymphadenectomy and intracorporeal VIP orthotopic neobladder. DaVinci SI-system with four arms and seven-port access was used. Cystectomy and pelvic lymphadenectomy were performed. After confirming negative frozen section of the proximal urethral end and distal margin of ureters, ileal loop of 40 cm was isolated. Adequate mobilization of ileum to perform tension-free urethroileal anastomosis was done. Using Endo GIA stapler, ileum was cut. “U”-shaped loop of 30 cm ileum was used. Extension of 10 cm folded ileum was added to proximal ileal loop. Urethroileal anastomosis with 3-0 barbed suture was performed after approximating rectoprostatic fascia. Ileum was opened on antimesenteric border and suturing was done to make VIP reservoir. Both ureters were separately anastomosed directly to lateral horns of the reservoir. Ureters were stented using infant feeding tubes (IFTs). Drain was placed. Results: Operative time was 412 minutes. Console time was 357 minutes. Blood loss was 375 mL. No Intraoperative Adverse Event happened according to the ICARUS Global Surgical Collaboration Criteria.2 Drain was removed on post-operative day (POD) 4. The patient was discharged on POD 8 with per urethral catheter, supra pubic catheter, and both IFTs, which were removed 3 weeks after surgery after a cystogram. Conclusions: Robot-assisted technique for totally intracorporeal bladder replacement with VIP neobladder is feasible and replicates the technical steps of open reconstruction. No competing financial interests exist. Runtime of video: 5 mins 44 secs Authors' Contributions: S.K.S. contributed to conceptualization, methodology, and supervision. M.A. carried out investigation, data curation, and writing original draft. U.S.S. was involved in review and editing, and writing original draft. S.R. took charge of review and editing, and observation. A.M. took charge of data curation and observation. H.R. carried out validation. A.S. carried out data curation. U.P.S. was in charge of review and editing. Acknowledgment: The authors thank the Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, for its support in patient management. Consent for Publication: Written informed consent was obtained from the patient to publish the details without disclosing the identity. Patient Consent Statement: Written informed consent was obtained from the patient for publication of the video without disclosing his identity.