V12-05 ROBOTIC INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION: TIPS AND TRICKS

Abstract

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-05 ROBOTIC INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION: TIPS AND TRICKS Akbar Ashrafi*, Rutveej Patel, Luis Medina, Andre de Castro Abreu, Andre Berger, Monish Aron, Inderbir Gill, and Mihir Desai Akbar Ashrafi*Akbar Ashrafi* More articles by this author , Rutveej PatelRutveej Patel More articles by this author , Luis MedinaLuis Medina More articles by this author , Andre de Castro AbreuAndre de Castro Abreu More articles by this author , Andre BergerAndre Berger More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, there has been a trend towards increasing use of completely intracorporeal ileal conduit urinary reconstruction after robotic-assisted cystectomy. METHODS: This video provides a step-by-step approach to robotic ileal conduit urinary diversion. The key steps of the procedure are as follows: 1) patient positioning and port placements; 2) identification of the ureters and bowel segment; 3) isolation of the bowel segment to be used for the conduit; 4) discarding a segment of bowel if required; 5) side-to-side bowel anastomosis; 6) Closure of the open end of the side-to-side anastomosis; 7) ureteroileal anastomosis over a ureteral stent 8) Fashioning of the stoma in the usual rose-bud manner. RESULTS: Some of the useful tips we recommend are to 1) use Cadiere forceps throughout the diversion to facilitate atraumatic handling of bowel and ureter; 2) use the 4th arm to hold up the distal end of the conduit to ensure adequate length and mobility; 3) elevate the tip of the laparoscopic stapler to ensure no bowel or mesentery has been entrapped before firing every time; 4) introduce the stapler from the lateral assistant port for all bowel work except the final load to close the open end of the side-to-side anastomosis; 5) use a suture to mark the bowel segments to be used for the anastomosis as soon as the bowel is divided; 6) consider discarding a small segment of bowel proximally to improve conduit mobility; 7) use ICG to assess ureteral vascularity before excising the distal ureter and completing the uretero-ileal anastomosis; 8) Use a double J stent through a miniport to simplify stent placement and minimize risk of stent extrusion. CONCLUSIONS: Completely intracorporeal robotic ileal conduit urinary reconstruction can be a challenging procedure. In this video, we provide a standardized step-by-step approach to this procedure with some tips and tricks to avoid common pitfalls and improve efficiency. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1111-e1111 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akbar Ashrafi* More articles by this author Rutveej Patel More articles by this author Luis Medina More articles by this author Andre de Castro Abreu More articles by this author Andre Berger More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...