The Robotic Intracorporeal Vesuvian Orthotopic Neobladder (VON)—A New Technique for Continent Urinary Diversion: Initial Experience and Description of the Technique

Abstract

Orthotopic neobladder reconstruction is becoming an increasing option as a urinary diversion following cystectomy for bladder cancer. The purpose of the following article is to describe, step-by-step, our technique for the robotic intracorporeal neobladder, the Vesuvian Orthotopic Neobladder. The primary aim of this new surgical procedure is to simplify and speed up the reservoir reconstruction, while at the same time obtaining an appropriate reservoir capacity. The Vesuvian Orthotopic Neobladder was performed employing an intestinal tract of 36 cm which was successively shaped in order to form a reservoir with three horns (left, right, and caudal), formed via the use of a mechanical stapler. Both ureters were stented and anastomosed to the left and right horn while the urethral-neobladder anastomosis was performed with the caudal horn. In this initial experience, two male patients with non-metastatic muscle-invasive bladder cancer underwent radical cystectomy followed by Vesuvian Orthotopic Neobladder reconfiguration. The mean age was 58.5 ± 3.53 years while the mean overall operative time was 435 ± 35.35 min, with an average neobladder reconstruction time of 59 ± 4.24 min. No intraoperative or postoperative complications were reported. The new intracorporeal Vesuvian Orthotopic Neobladder technique is a feasible and good alternative to traditional robotic intracorporeal orthotopic bladder procedures, permitting us to reduce operative time and obtain a neobladder with a fair reservoir capacity.