Totally intracorporeal robot-assisted vescica ileale padovana (vip) using staplers: a stepwise approach
INTRODUCTION AND OBJECTIVES: Robotic radical cystectomy with intracorporeal neobladder reconstruction is gaining popularity. Nevertless the procedure is still considered complex and characterized by a long operative time. The video shows our step by step technique of robotic intracorporeal VIP using staplers to construct part of the reservoir.
METHODS: From August 2012 to October 2014, 91 patients underwent robotic intracorporeal VIP using staplers to construct part of the reservoir. We performed RRC, extended lymphadenectomy, and totally intracorporeal Padua neobladder. The surgical technique is shown in
the accompanying video. RESULTS: Totally intracorporeal VIP was successfully performed in all 91 patients. Mean estimated blood loss was 200 ml (SD 60), median operative time (console time) was 4.2 hours (range: 4-6 hours), median time to regular diet was 6 d (range: 5–21 d), median hospital stay was 8 d (range: 6–45 d). No intraoperative complications occurred. Minor complications (Clavien grade 1-2) occurred in 27% of the patients while major complications (Clavien grade 3-5) were detected in 9% of the patients. No stones in the neobladder were observed during the follow-up.
CONCLUSIONS: Robot-assisted orthotopic neobladder (VIP) is feasible and safe. The partially stapled neobladder we presented could shorten operative time for totally intracorporeal urinary diversion.