Robot-assisted Bladder Diverticulectomy Research Articles

VE01 Robot assisted bladder diverticulectomy and radical prostatectomy a combined technique

VE01 Robot assisted bladder diverticulectomy and radical prostatectomy a combined technique

Robotic bladder diverticulectomy with concurrent management of bladder outlet obstruction: A choice to consider.

Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.

Robot Assisted Bladder Diverticulectomy Seven Year After Radical Prostatectomy

Robot Assisted Bladder Diverticulectomy Seven Year After Radical Prostatectomy

Robot-assisted bladder diverticulum removal in a 10-year-old child

BACKGROUND: Bladder diverticulum are hernias of the bladder mucosa that prolapse through a detrusor defect. Diverticulectomy is the treatment of choice for this disease. Surgical methods to implement this principle include open, laparoscopic and robotic approaches. In the present study, we outline our own technique for performing robotic diverticulectomy and report its short-term results.&#x0D; CLINICAL CASE DESCRIPTION: The study reports one case of bladder diverticulectomy performed with a robot-assisted technique in a 10-year-old boy. The diagnosis of the disease was established using voiding cystourethrography, cystoscopy and X-ray computed urography. The patient had robot-assisted bladder diverticulectomy using transperitoneal extravesical access. At the final stage of the study, short-term outcomes of the robot-assisted procedure were evaluated. The duration of the operation was 100 minutes. No intraoperative and postoperative complications were observed. The urinary catheter was removed the day after the operation. The duration of the patient's stay in the hospital was 7 days. Histological examination showed signs corresponding to a false diverticulum of the bladder with the presence of single muscle fibers in its structure. The ureteral stent was removed one month after the operation. After removal of the stent, control voiding cystography was performed, which demonstrated the absence of bladder contour deformation at the site of surgical procedure.&#x0D; CONCLUSION: Robot-assisted bladder diverticulectomy is a technically feasible approach to the treatment of congenital bladder diverticulum.

Robot-assisted bladder diverticulectomy in a 9-year-old boy

Pediatric urologists rarely encounter bladder diverticulum in children. If the bladder diverticulum has clinical manifestations such as pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis, then surgical treatment is indicated. Recently, numerous publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications have reported on the removal of a bladder diverticulum in children using a robotic approach. A 9-year-old boy who was diagnosed with a bladder diverticulum underwent robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports of da Vinci 12 and two 8-mm ports, as well as an assistant 5-mm port, were used, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 min, and the console time was 75 min. The blood loss volume was 20 mL. The patient was in the intensive care unit for 1 day. The urethral catheter was removed on day 7 after the operation. Urination independence, delays, and incontinence were not noted. The patient was discharged on postoperative day 9 in satisfactory condition. At the control examination after a year at the patients residence, she had no complaints, urination was not disrupted, and there were no pathological changes in the ultrasound of the kidneys and bladder. Robot-assisted bladder diverticulectomy in children is a feasible, effective, and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia, which was performed using a robotic system in pediatric practice.

V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE

You have accessJournal of UrologyCME1 Apr 2023V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE Francesco Ditonno, Alessandro Veccia, Giovanni Novella, Lorenzo De Bon, Paola Irene Ornaghi, and Alessandro Antonelli Francesco DitonnoFrancesco Ditonno More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Giovanni NovellaGiovanni Novella More articles by this author , Lorenzo De BonLorenzo De Bon More articles by this author , Paola Irene OrnaghiPaola Irene Ornaghi More articles by this author , and Alessandro AntonelliAlessandro Antonelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the surgical technique for robot-assisted wire-guided extravesical bladder diverticulectomy and simultaneous Y-V plasty for recurrent bladder neck stricture. METHODS: A 58-year-old man referred to our center for recurrent LUTS after TURP. Thereafter, the patient underwent TUIP and 2 endoscopic bladder neck incisions, unsuccesfully. A CT scan showed two bladder diverticula of 4 and 8 cm located on the right and left postero-lateral wall, respectively. The patient was scheduled for robot-assisted bladder diverticulectomy and Y-V plasty for recurrent bladder neck stricture. As first step, a double J stent was placed bilaterally and a guidewire was inserted in the lumen of each diverticulum to facilitate their identification and handling. The robotic stage was performed with Da Vinci Xi platform, with the patient in supine position, with a 25 degrees Trendelemburg. Six ports were placed across the lower abdomen, transperitoneally: four 8 mm robotic trocars and 2 assistant trocars (12 and 5 mm). The peritoneum was incised to expose posterolateral bladder wall. Perivesical fat was dissected and protruding mucosa of the diverticula isolated. A blunt dissection was mostly used, detaching the mucosa from the bladder wall. Once completely isolated, bladder mucosa was entirely excised and the neck of the diverticulum closed with a triple-layer continuous 3-0 monofilament absorbable suture. Retzius space was then opened and prostatic defatting was performed. The bladder neck was incised obtaining a Y-shaped flap. Two stay 3-0 monofilament sutures were placed at the end of the two branches of the Y. The flap was advanced and the margins closed with a double-layer emicontinuous 3-0 barbed absorbable suture. RESULTS: Operative time was 318 min. Estimated blood loss was 200 mL. There were no perioperative or postoperative complications. A voiding cystourethrogram before catheter removal, after 12 days, showing almost complete resolution of diverticular protrusion. Ureteral stents were removed 30 days post-operatively. CONCLUSIONS: Robot-assisted extravesical diverticulectomy and simultaneous Y-V plasty of the bladder neck is a safe and feasible procedure. Endoscopic guide-wire insertion into the diverticulum allowed for easier traction and dissection of the tissues. Advantages of the procedure consist of avoidance of cystotomy, easy individuation and excision of diverticular mucosa and concomitant resolution of relapsing cervico-urethral obstruction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Ditonno More articles by this author Alessandro Veccia More articles by this author Giovanni Novella More articles by this author Lorenzo De Bon More articles by this author Paola Irene Ornaghi More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement PDF downloadLoading ...

V77 - Complex robot-assisted bladder diverticulectomy with endoscopic assistance

V77 - Complex robot-assisted bladder diverticulectomy with endoscopic assistance

Transvesical Approach in Robot-Assisted Bladder Diverticulectomy: Surgical Technique and Outcome.

Objective: Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTIs). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes. Patients and Surgical Procedure: We retrospectively analyzed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is observed. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture. Results: Median age was 66 years (interquartile range [IQR] 60-69). The number of diverticula removed ranged from 1 to 3. Ten patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 minutes (IQR 120-180), median estimated blood loss was 250 mL (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). One patient developed urinary leakage after catheter removal, one patient developed a UTI. Median follow-up was 9 months (IQR 3.5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 mL (IQR 0-111), with a median decline of 120 mL (IQR -402 to -33). Conclusions: Transvesical approach for RABD is a safe and reliable technique that gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterization time is short. No relapse has been observed.

PT038 - Robot-assisted bladder diverticulectomy: Perioperative and functional outcomes of a multicenter study

PT038 - Robot-assisted bladder diverticulectomy: Perioperative and functional outcomes of a multicenter study

VE50 - Robot assisted bladder diverticulectomy: Our experience

VE50 - Robot assisted bladder diverticulectomy: Our experience

VE56 - Laparoscopic robot-assisted bladder diverticulectomy after transurethral resection of the prostate: Surgical technique

VE56 - Laparoscopic robot-assisted bladder diverticulectomy after transurethral resection of the prostate: Surgical technique

Robotic Surgical Approaches to Bladder Reconstruction in Adults

Robot-assisted urologic surgeries have demonstrated safety and efficacy. While pioneered for urologic oncology cases, robot-assisted surgeries have subsequently been successfully applied in urologic pelvic reconstructive procedures. Robot assistance in reconstructive surgeries enables the surgeon’s ability to handle delicate suturing, eliminating many challenges of pure laparoscopic suturing. Robotic technology also greatly improves visualization in the pelvis. Thus, robotics facilitates the possibility for minimally invasive techniques in reconstructive pelvic surgeries, reducing length of stay and blood loss and allowing faster recovery. As in all surgeries, positioning and setup contributes to the ease of the entire procedure. This article aims to discuss key points in robot-assisted bladder diverticulectomy, ureteral reimplants, urinary diversions, and repair of vesicovaginal fistulae.

V8-05 CONCOMITANT HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) AND LAPAROSCOPIC ROBOT-ASSISTED BLADDER DIVERTICULECTOMY FOR TREATMENT OF A LARGE BLADDER TUMOR

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2015V8-05 CONCOMITANT HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) AND LAPAROSCOPIC ROBOT-ASSISTED BLADDER DIVERTICULECTOMY FOR TREATMENT OF A LARGE BLADDER TUMOR Adam C. Calaway, David Y. Yang, Jessica E. Paonessa, James E. Lingeman, and Ronald S. Boris Adam C. CalawayAdam C. Calaway More articles by this author , David Y. YangDavid Y. Yang More articles by this author , Jessica E. PaonessaJessica E. Paonessa More articles by this author , James E. LingemanJames E. Lingeman More articles by this author , and Ronald S. BorisRonald S. Boris More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2129AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder diverticula may be congenital or acquired. Acquired diverticula are often secondary to elevated intravesical pressure related to bladder outlet obstruction (BOO) and benign prostate hyperplasia (BPH). Bladder tumors occur in bladder diverticula in 1-13% of cases and can be a therapeutic dilemma. Historically, bladder tumors in diverticula have presented at more advanced stages necessitating aggressive surgical extirpation. Recently, partial cystectomy with bladder diverticulectomy has been performed with comparable disease-free survival. Here we describe a patient with long standing BOO and BPH who additionally has a large bladder diverticulum containing a substantial bladder tumor. Video of concomitant HoLEP and laparoscopic robot-assisted bladder diverticulectomy is demonstrated. METHODS A 67 year old male was referred for evaluation of gross hematuria and lower urinary tract symptoms. His initial AUA symptom score was 22. Cystoscopy demonstrated an enlarged prostate with intravesical extension, diffuse trabeculations and a large bladder diverticula located cephalad and lateral to the left ureteral orifice. A large localized bladder tumor was visualized emanating from the diverticula. A CT scan confirmed these findings. Bladder biopsies were performed showing high-grade pTa urothelial carcinoma. Surgical management to treat both BPH and bladder tumor was planned. RESULTS HoLEP was completed without complication and minimal blood loss. Enucleation time was 45 minutes. A 5 French localizing ureteral stent was placed to help identify the left ureter during the diverticulectomy. The robot was then docked for the diverticulectomy. A standard left pelvic lymph node dissection was performed. The bladder was closed in two layers and the specimens were obtained. A drain and a foley catheter were left at the conclusion of the procedure. Total operative time was 201 minutes. Final pathology was pT1 high grade urothelial carcinoma with 0/4 lymph nodes positive. Induction BCG was completed in the post-operative period. After 1 year of follow-up, the patient remains free of recurrence. Most recent AUA symptom score is now 5 with a bother score of 0. CONCLUSIONS Concomitant HoLEP and robotic-assisted laparoscopic bladder diverticulectomy is a safe and feasible operation for men with BPH and a large bladder tumor within a diverticulum. Early oncologic outcomes are encouraging. Larger cohorts and longer follow up are needed to confirm initial findings. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e715 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam C. Calaway More articles by this author David Y. Yang More articles by this author Jessica E. Paonessa More articles by this author James E. Lingeman More articles by this author Ronald S. Boris More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-Assisted Bladder Diverticulectomy

To describe our technique for robot-assisted bladder diverticulectomy (RABD). Ten patients underwent RABD using an extra- or transvesical approach. Three (30%) patients underwent concomitant procedures: Robot-assisted radical prostatectomy, robot-assisted simple prostatectomy, and transurethral resection of the prostate. All RABDs were performed successfully. Median estimated blood loss, operative time, and diverticulectomy time were 75 mL, 210 minutes, and 80 minutes, respectively. Median follow-up time was 18 months. Median International Prostate Symptom Score decreased by 57%, P=0.001. RABD is feasible and safe. It can be performed via a trans- or extravesical approach, as a stand-alone, or concomitant procedure.

Robot-Assisted Bladder Diverticulectomy in the Pediatric Population

Surgical intervention is warranted for symptomatic congenital bladder diverticula (CBD) in children. We hypothesized that a robot-assisted approach to bladder diverticulectomy could be performed with safety and with good efficacy. Descriptions of our approach and results with robot-assisted laparoscopic bladder diverticulectomy (RALBD) are presented. We retrospectively reviewed a prospective database with Institutional Review Board approval. Eligible patients were those who underwent excision of a bladder diverticulum via a robotic approach. Data were collected on presenting symptoms, and intraoperative and postoperative courses. Voiding cystourethrography (VCUG) was performed at 3-month follow-up. Renal and bladder ultrasonography was performed at 3- and 12-month follow-up. Fourteen patients were identified. Of the 14 patients, 6 also had a history of diurnal enuresis. Mean patient age was 7.9 years (range 4-13 years). The operation was performed via a transperitoneal approach with robot assistance. The mean operative time (including cystoscopy) was 132.7 minutes (range 113-192 min). The average length of stay was 24.4 hours (range 18-31 hours). There were no intraoperative or postoperative complications in this group. Each patient was followed for at least 1 year. All patients had a normal results of VCUG on follow-up without evidence of a diverticulum. Within 3 months, diurnal enuresis resolved in 6/6 patients. RALBD appears to be a safe and effective modality for treatment of patients with CBD. It can serve as an alternative to the open surgical approach.

Intravesical Methylene Blue Facilitates Precise Identification of the Diverticular Neck During Robot-Assisted Laparoscopic Bladder Diverticulectomy

The aim of this report is to describe our surgical technique for robot-assisted laparoscopic bladder diverticulectomy. In this technique, methylene blue is instilled into the bladder to aid in intra-abdominal identification of the diverticular neck. We retrospectively reviewed the records of patients who underwent robot-assisted bladder diverticulectomy by a single surgeon. Between September 2008 and January 2011, 5 patients successfully underwent robot-assisted laparoscopic bladder diverticulectomy using 1% intravesical methylene blue. All cases were completed without intraoperative complication or need for open conversion. Mean operative time was 216 minutes, with a mean estimated blood loss of 45 mL. Patients were discharged 1-2 days following surgery. No patient experienced a perioperative complication. The robot-assisted approach for bladder diverticulectomy is a viable alternative to both open and laparoscopic surgery. The use of intravesical methylene blue greatly aids in identification of the diverticular neck during this procedure.

V1544 ROBOT-ASSISTED BLADDER DIVERTICULECTOMY

You have accessJournal of UrologyReconstruction1 Apr 2010V1544 ROBOT-ASSISTED BLADDER DIVERTICULECTOMY Marcelo Orvieto, Rafael Coelho, Sanket Chauhan, Bobby Ardila, Kenneth Palmer, and Vipul Patel Marcelo OrvietoMarcelo Orvieto More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Sanket ChauhanSanket Chauhan More articles by this author , Bobby ArdilaBobby Ardila More articles by this author , Kenneth PalmerKenneth Palmer More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1296AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The open approach has traditionally been utilized for the surgical management of bladder diverticuli. With increasing popularity and experience, laparoscopic and most recently, robot-assisted bladder diverticulectomy have been described. However, intracorporeal identification of the divierticulum can be challenging. The following video exemplifies the use of robot-assistance with combined endoscopic assistance during bladder diverticulectomy. METHODS A 63-year-old patient with long-term history of lower urinary tract symptoms status post TURP, presented to our office with recurrent urinary tract infections and elevated post-void residuals. Cystoscopic examination revealed a large bladder diverticulum in the retro-trigonal area. The patient elected to undergo robot-assisted bladder diverticulectomy. Prior to docking the robot, bilateral ureteral catheters were placed and the rigid cystoscope was kept in the bladder during the entire case to assist with intracorporeal diverticular identification and dissection. Using this method, the diverticulum was easily recognized and dissected from the surrounding tissue with violating it. After, the diverticulum was fully excised, the bladder was closed in two layers. RESULTS Total operative time was 90 minute and blood loss was 50cc. The patient was discharged on postoperative day (POD) number 1. A cystogram on POD #6 before the Foley catheter was removed confirmed indemnity of the bladder. CONCLUSIONS Robot-assisted bladder diverticulectomy is feasible and provides the benefits of the minimally invasive approach to patients. Combined endoscopic visualization facilitates intracorporeal recognition and dissection of the diverticulum. Celebration, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e595 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcelo Orvieto More articles by this author Rafael Coelho More articles by this author Sanket Chauhan More articles by this author Bobby Ardila More articles by this author Kenneth Palmer More articles by this author Vipul Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cystoscope- and Robot-Assisted Bladder Diverticulectomy

Background and Purpose: Minimally invasive approaches to manage bladder diverticula have become increasingly popular; however, intracorporeal identification of bladder diverticula may be challenging. We report a novel technique for diverticular illumination using flexible cystoscopy. Patients and Methods: After management of bladder neck obstruction, two patients with bladder diverticula and persistent lower urinary tract symptoms underwent robot-assisted bladder diverticulectomy. Cystoscopic illumination was used in both cases to aid diverticular identification and dissection. This video illustrates the steps of this approach in a patient with a 7 cm posterior and a 3 cm left lateral diverticulum. The steps include (1) externalized ureteral stent placement; (2) placement of laparoscopic ports in a configuration similar to that required for robotic cystectomy; (3) incision of peritoneum overlying posterior bladder; (4) exposure of diverticulum; (5) transurethral insertion of a flexible cystoscope into the diverticulum for transillumination and identification of the diverticular wall; (6) diverticular dissection down to its ostium; (7) transection of diverticulum at its ostium; (8) bladder closure in two layers; (9) confirmation of water-tight closure with bladder distension; and (10) insertion of Foley catheter and perivesical drain. Results: The perivesical drain was removed on postoperative day 1 and the patient was discharged on postoperative day 2. A cystogram on day 6 revealed no evidence of residual diverticula or leak, and the Foley catheter was removed. Conclusions: Our technique was simple to perform and facilitated identification and dissection of bladder diverticula. Cystoscope-assisted illumination provides a straightforward method of identifying bladder diverticula during robot-assisted laparoscopic diverticulectomy. Runtime of video: 3 min 55 sec

Robot-Assisted Laparoscopic Bladder Diverticulectomy Combined with Photoselective Vaporization of Prostate: A Case Report and Review of Literature

Open surgery, endoscopic technique, and standard laparoscopic technique are surgical options for the management of bladder diverticuli. In this article, we report robot-assisted bladder diverticulectomy (RABD) and photoselective vaporization of prostate (PVP) in the same patient sequentially. To the best of our knowledge, this is the first case report of RABD combined with PVP. A 63-year-old patient with benign prostatic hyperplasia and a secondary large bladder diverticulum underwent sequential PVP and RABD. Cystoscopic examination revealed obstructing prostate lobes and a large diverticulum at posterior wall of bladder. After completion of PVP procedure, a 16F urethral catheter was inserted into the diverticulum via outer sheath of optic urethrotome and another 16F urethral catheter was left in bladder for urinary drainage. A transperitoneal approach was preferred. The diverticulum was distended with saline infusion via the Foley catheter inside the diverticulum. The distended diverticulum was seen easily and dissected from the surrounding tissue. The bladder was closed in two separate layers. Total operative time, including diverticulectomy with PVP procedure, was 230 minutes, and console time was 90 minutes. The length of stay was 7 days. There has been always concern about the high intravesical pressures secondary to irrigant instillation that may disrupt the bladder repair. To avoid this problem we combined robotic diverticulectomy with PVP. Because of hemostatic properties of potassium-titanyl-phosphate laser, we did not encounter with bleeding after prostatectomy procedure. Moreover, we did not use irrigation, and the suture line of the bladder was kept safe. Therefore, we recommend to use greenlight laser in combined prostate and RABD operations. RABD is a feasible and safe procedure. RABD and PVP can be performed safely in the same patient sequentially.

Cystoscope- and Robot-Assisted Bladder Diverticulectomy

Minimally invasive approaches to manage bladder diverticula have become increasingly popular; however, intracorporeal identification of bladder diverticula may be challenging. We report a novel technique for diverticular illumination using flexible cystoscopy. After management of bladder neck obstruction, two patients with bladder diverticula and persistent lower urinary tract symptoms underwent robot-assisted bladder diverticulectomy. Cystoscopic illumination was used in both cases to aid diverticular identification and dissection. Our technique was simple to perform and facilitated identification and dissection of bladder diverticula. Postoperative cystography revealed no evidence of residual diverticula. Cystoscope-assisted illumination provides a straightforward method of identifying bladder diverticula during robot-assisted laparoscopic diverticulectomy.