Elsevier

European Urology

Volume 44, Issue 3, September 2003, Pages 337-339
European Urology

Robotic-Assisted Laparoscopic Radical Cystectomy and Intra-Abdominal Formation of an Orthotopic Ileal Neobladder

https://doi.org/10.1016/S0302-2838(03)00301-4Get rights and content

Abstract

Purpose: To describe our technique of robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic neobladder (Hautmann) for treatment of transitional cell carcinoma of the bladder.

Methods: We describe our surgical technique in the worldwide first attempt to perform a robotic-assisted laparoscopic radical cystectomy and completely intra-abdominal formation of an orthotopic neobladder. The DaVinci System™ (Intuitive Surgical, Mountain View, CA, USA) was utilized to perform the procedure.

Results: Utilizing the DaVinci System the operation could be performed without any complications. Operating time was 8.5 hours, blood loss was 200 ml. The oncologic as well as the functional result of the reservoir were excellent.

Discussion: We here demonstrated that sophisticated laparoscopic procedures like the intra-abdominal formation of an orthotopic neobladder are accomplishable with robotic assistance.

Introduction

Laparoscopic surgery in conventional and especially robotic-assisted technique has expanded from simple ablative operations (e.g. nephrectomy) to more challenging ablative (e.g. radical prostatectomy) and even reconstructive (e.g. pyeloplasty) procedures. In case of tumor surgery, results of the laparoscopic approach equals that of open surgery [1]. Since the introduction of the robotic-assisted technique in urology in May 2000 this technique is preferred in our department [2]. Excellent three-dimensional (3D) vision (InSite Vision System™), physiological eye-hand coordination, extended grades of freedom (Endowrist™ technology) and a fast learning curve are the advantages of this system. Therefore, major surgical procedures can more easily be performed in a laparoscopic fashion. Here, we report the initial case of a laparoscopic robotic-assisted radical cystectomy and complete intra-abdominal formation of an orthotopic ileal neobladder for the treatment of transitional cell carcinoma of the bladder.

Section snippets

Patient and surgical technique

A 58-year-old white male with a 9-year history of bladder carcinoma and multiple transuretheral resections as well as intravesical instillation therapy was transferred to our department for radical cystectomy for invasive transitional cell carcinoma. After obtaining informed consent and standard mechanical bowel preparation, we performed the whole procedure in a laparoscopic robotic-assisted manner.

The procedure was performed using a DaVinci System (Intuitive Surgical, Mountain View, CA, USA).

Discussion

We here present the worldwide first case of an robotic-assisted laparoscopic cystectomy and formation of an orthotopic ileal neobladder where the complete procedure was performed intra-abdominally.

Turk et al. reported a case of a conventional laparoscopic cystectomy and insertion of the ureters in the sigmoid [3]. However, the formation of an orthotopic ileal neobladder has never been performed intra-abdominally via a robotic-assisted laparoscopic approach. Meng et al. just recently reported

References (4)

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