The robotic intracorporal Hautmann orthotopic neobladder

Overview

Introduction: The daVinci robotic system with modern EndoWrist tools enables a miniinvasive approach to intracorporeal reconstruction of orthotopic neobladder after cystectomy.

Description of the clinical case: We performed 42 robotic radical cystectomies since January 2010 to June 2018. We had used the robotic system daVinci standard until December 2013, then we used daVinci Si. During procedures patients were positioned in 30 degrees Trendelenburg position. After the ablation phase of cystectomy orthotopic neobladder was created intracorporally, in 5 cases according to Hautmann. We are presenting the Hautmann neobladder reconstruction in which we have used about 60 centimeters of preterminal ileum. Bowel continuity was restored by continuous end to end suture. Excluded bowel loop was remodeled after partial detubulization to W shape, then we sutured it to the remainder of urethra. The non-tubularized afferent parts of bowel loop were attached to stented urinary ducts. Mean age of the patients was 62 years (56-68), mean BMI was 24 (17-32). Mean time of surgery procedure was 150 minutes (120-200) and mean time of hospital stay was 10 days (8-14). Three weeks after, the surgery cystogram with cathether removal was performed. In postsurgery period, we did not register prolonged bowel passage, neobladder leak or any serious complications.

Conclusion: The robotic orthotopic neobladder reconstruction according to Hautmann is a safe and technically feasible intracorporal method of urine derivation after robotic radical cystectomy.

Keywords:

robotic surgery – Bladder cancer – orthotopic neobladder