A Simplified Approach to Intracorporeal Robot-Assisted Laparoscopic Ileal Conduit Formation

Abstract

Introduction: During robot-assisted radical cystectomy, urinary diversions are often performed extracorporeally. However, an optimized minimally invasive technique is possible with total intracorporeal urinary diversion. In this video, we provide a step-by-step demonstration of a simplified approach to the intracorporeal robot-assisted laparoscopic ileal conduit with the Wallace and Bricker anastomosis. Methods: A total intracorporeal ileal conduit formation was performed using the da Vinci robotic surgical system. During ureteral dissection and tunneling, the sigmoid colon was retracted using a dual-blade retractor. A 15-cm segment of ileum ~20 cm from the ileocecal valve was used for the conduit. A 60-mm endoscopic stapler was used to staple, transect, and restore the continuity of bowel segments. Both the Bricker and Wallace ureteroileal anastomoses were performed using a 4-0 monofilament absorbable suture on an RB-1 needle in a continuous manner. Results: This technique of robot-assisted total intracorporeal ileal conduit urinary diversion was performed in 11 patients. No patients developed uretero-enteric or entero-enteric anastomotic leak. One patient required re-operation for bowel obstruction. When performed along with robotic assisted cystectomy and lymphadenectomy, mean total operative time was 445 minutes and mean hospital stay was 7 days. Conclusion: Robotic total intracorporeal ileal conduit urinary diversion offers a truly minimally invasive technique that can be performed for a variety of indications, regardless of the need for specimen extraction. While following similar steps to the traditional Bricker or Wallace anastomosis, the robotic intracorporeal approach utilizes precise control of surgical instruments and allows for a meticulous dissection with minimal blood loss. For patients undergoing radical cystectomy, females bore no abdominal incisions other than port sites since the specimen is removed through the vagina. In males, the incision can be limited to ~5 cm and placed either periumbilical or Pfannenstiel. The authors declare that no competing financial interests exist. Runtime of video: 5 mins