This video depicts a robot-assisted laparoscopic cystectomy with intracorporeal ileal conduit for patients with muscle-invasive bladder cancer. The procedure may be done in a non-nerve-sparing, nerve-sparing, or partially nerve-sparing fashion accompanied by an extended pelvic lymph node dissection. Special emphasis is placed on performing the urinary diversion totally intracorporeally using the Wallace technique for ureteroileal anastamosis.
Dr. Hotaling: Dr. Dechet demonstrates many techniques to help perform a reproducible and efficient intracorporeal cystectomy, extended node dissection using a split and roll technique, and ileal conduit. The use of a split and roll technique in conjunction with the port placement allow a thorough extended node dissection that excellently recapitulates open surgery. Further, use of sutures on Hem-O-Lok clips placed on the divided ureters prevent wasted time searching for the ureters at the time diversion. Clips on the foley catheter also allow easy manipulation of the relevant structures. Identification of the proper length of ileum is readily done by stretching the ileum between pelvic landmarks. This video serves as a reference for how high-volume open urologic oncologists can readily translate open surgery to a minimally invasive approach in a safe and efficient manner.
Section Editor’s note: ‘Y’tube, a video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. In this installment, Drs. Santomauro, Warner, and Dechet describe robot-assisted cystectomy and urinary diversion. The surgeons demonstrate the importance of clear visual identification of relevant structures, use of colored sutures to help reconstruction, novel use of a V-lock suture in bowel reconstruction, and excellent recreation of open surgical techniques using a minimally invasive approach. As robotic and oncologic surgeons continue to push the limits of what can be done robotically, these videos will serve as an important reference for other surgeons.
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Dr. Dechet is associate professor of surgery (urology) and co-director of the urologic oncology multidisciplinary group at the Huntsman Cancer Institute, University of Utah, Salt Lake City.