Robot-assisted Laparoscopic Partial Cystectomy Research Articles

Robotic partial cystectomy with excision of mesh after inguinal hernia repair: a case report

BackgroundMesh erosion into the bladder after hernioplasty is sparsely reported in literature and may be underestimated in clinical practice. We report a case of a patient who was referred to our department due to recurrent urinary tract infections caused by a bladder stone due to mesh migration after inguinal hernia repair 22 years ago.Case presentationA 67-year-old male patient was referred from the outpatient urologist for transurethral resection of the prostate in September 2021 due to recurrent urinary tract infections caused by benign prostatic enlargement and bladder stone formation. During the operation, parts of the stone were smashed and the prostate was resected. Additionally, a mesh eroding from the bladder roof was detected masqueraded by the stone. A computed tomography scan, which was performed afterwards, revealed a 20 × 25 mm mesh migration into the bladder after inguinal hernia repair on the left with concomitant stone adhesion to the mesh. After revealing patient history, an inguinal hernia repair with mesh implantation was done 22 years ago. A robotic assisted partial cystectomy and mesh excision was performed. The patient recovered well.ConclusionMesh erosion into the urinary bladder after hernia repair can occur up to two decades after the primary operation. Although it is rarely reported, it can be a possible cause for recurrent urinary tract infections and therefore a mentionable complication after inguinal hernia operation. Robotic-assisted laparoscopic partial cystectomy with complete excision of the mesh is an option for definitive treatment.

Back from the Bread: Delayed Presentation of an Ingested Foreign Body

Background: Foreign body ingestion is often uneventful and rarely requires surgical intervention. It can however become problematic, predominantly affecting the gastrointestinal tract or more rarely the genitourinary tract. Few cases of the latter have been described. Objective: The aim of this case report is to raise awareness of the potentially indolent presentation of foreign body ingestion resulting in urological complications. Method: We report a unique case of a forty year old presenting with suprapubic pain, urgency and frequency twenty years following inadvertent ingestion of a needle. Results: Following initial investigation for common causes of lower urinary tract symptoms, ultrasound and computer tomography located the needle within a perivesical cavity associated with the bladder dome. Attempted removal via laparoscopy and open approach was unsuccessful. The patient ultimately underwent robotic assisted laparoscopic partial cystectomy in order to excise the cavity and foreign body. Conclusion: Extra-luminal migration of foreign bodies from the gastrointestinal to the genitourinary tract is rare but should be considered as a differential for urological symptoms in difficult cases when the aetiology remains elusive. Access to radiological imaging remains vital to enabling verification of the diagnosis. Optimal management involves localisation and excision of the foreign body and any containing cavity or fistulae. This may require advanced techniques including intra-operative imaging and a robotic-assisted laparoscopic approach.

V08-02 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL CYSTECTOMY USING THE DA-VINCI SINGLE-PORT ROBOTIC SYSTEM

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-02 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL CYSTECTOMY USING THE DA-VINCI SINGLE-PORT ROBOTIC SYSTEM Michael Tonzi, and Amar Singh Michael TonziMichael Tonzi More articles by this author , and Amar SinghAmar Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report the initial case of an extraperitoneal, trans-vesicle robotic assisted laparoscopic partial cystectomy including en-bloc excision of a bladder diverticulum with urothelial carcinoma using the da Vinci Single Port robotic system. METHODS: A 64-year-old male with a history of urothelial carcinoma was found to have recurrence of his disease inside of a narrow neck bladder diverticulum on surveillance cystoscopy. Remaining bladder was evaluated with random biopsies and there was no evidence of urothelial carcinoma in the rest of the bladder. The da Vinci Single Port robotic system was used to perform an extraperitoneal, trans-vesicle partial cystectomy with en-bloc resection. The bladder was entered extra-peritoneally, and the robotic port was docked directly within the bladder using a small Gelport. The diverticulum containing the tumor was excised en-bloc from within the bladder circumferentially and the defect closed. RESULTS: The patient tolerated the procedure uneventfully. The total operative time was 112 minutes. The patient was discharged on postoperative day one. At follow up, cystography demonstrated no contrast extravasation and his urethral catheter was removed on post-operative day eight. Final pathology revealed negative surgical margins. CONCLUSIONS: This is the initial report of a trans vesicle robotic assisted en-bloc partial cystectomy for a recurrent urothelial carcinoma in a bladder diverticulum using the da Vinci Single Port robotic system. This provides an alternative to traditional minimally invasive approaches not amenable to trans-urethral resection. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e601-e601 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Tonzi More articles by this author Amar Singh More articles by this author Expand All Advertisement Loading ...

Tumores de vejiga no uroteliales , como reto diagnóstico y terapéutico

Introducción: El cáncer de vejiga se clasifica en general como urotelial y no urotelial. El no urotelial representa menos del 5% de todos los tumores vesicales y de estos el 90% son de origen epitelial, incluyendo: carcinoma de células escamosas, de células pequeñas y adenocarcinoma. El 10% restante es de origen no epitelial (linfoma, paranganglioma, sarcoma, etc.).
 Objetivo: Presentar la experiencia del cáncer de vejiga no urotelial y describir las características de los pacientes en nuestra institución.
 Materiales y métodos: Estudio retrospectivo y descriptivo de expedientes de pacientes con cáncer vesical no urotelial, diagnosticados y tratados en nuestro servicio de 2004 al 2016, obteniendo 7 casos.
 Resultados: 7 pacientes, 5 hombres y 2 mujeres. Edad 53 años (35-76). Síntomas principales hematuria 4, STUI 2 y mucosuria 1 . Histopatología: adenocarcinoma 3, carcinoma epidermoide 2, paraganglioma 1 y linfoma 1. Localización mas frecuente: domo vesical. Tratamiento: Adenocarcinoma (3): Cistectomía parcial 2, solo rtuv 1. Carcinoma epidermoide (2): 1 nefroureterectomía izquierda + cistoprostatectomía radical, 1 cistectomía radical + exenteración pélvica, ambos casos con RT adyuvante; Paraganglioma: 1 Cistectomía parcial laparoscópica asistida por robot, Linfoma: 1 rtuv + Quimioterapia + radioterapia. 2 defunciones por carcinoma epidermoide.
 Discusión: Dada la poca frecuencia de estos casos es difícil la estandarización entre el tratamiento y la histopatología, pero en general la cirugía es la mejor opción terapéutica para evitar la recurrencia y mejorar supervivencia, en algunos casos se recomiendan terapias conservadoras de órgano con terapias adyuvantes personalizadas a la histopatología.
 Conclusiones: El manejo de los tumores vesicales no uroteliales es complejo y requiere de un equipo multidisciplinario. Los tumores mas agresivos son epidermoides con alta posibilidad de extensión locorregional. La experiencia en México es limitada.

PE64 - Robot assisted laparoscopic partial cystectomy (RAPC) combined with brachytherapy catheter implantation (BCI) in selected muscle invasive bladder tumors

PE64 - Robot assisted laparoscopic partial cystectomy (RAPC) combined with brachytherapy catheter implantation (BCI) in selected muscle invasive bladder tumors

A Rare Location and Presentation of Pheochromocytoma.

Background: Pheochromocytomas typically are diagnosed in the adrenal gland and from the sympathetic nervous system. Bladder pheochromocytoma is a rare location for this tumor.Case Presentation: We describe a 67-year-old Afro Caribbean woman referred to our hospital for an asymptomatic bladder tumor. Preliminary transurethral resection revealed bladder pheochromocytoma. After a comprehensive endocrine evaluation, we performed a robot-assisted laparoscopic partial cystectomy with ureteral reimplantation.Conclusion: We present a rare case of bladder pheochromocytoma treated effectively with minimally invasive techniques. When confronted with a solid bladder mass, apart from the more common urothelial malignancies, a differential diagnosis of bladder pheochromocytoma should also be considered.

Perioperative outcomes of robot-assisted laparoscopic partial cystectomy.

Reports of surgical outcomes after robotic partial cystectomy are limited. The objective of this study is to review surgical outcomes after robotic partial cystectomy at a large tertiary referral center and compare outcomes with patients undergoing open partial cystectomy. Patients undergoing robotic partial cystectomy between 2003 and 2014 were identified. Patients were matched 2:1 based on gender, age, and Charlson Comorbidity Score with patients undergoing open partial cystectomy during the same time period. Patient charts were reviewed for surgical outcomes. Conditional logistic regression adjusted for matching was used to compare outcomes. At our institution, 11 patients underwent robotic partial cystectomy between 2003 and 2014. Median operative time was significantly longer in the robotic group, 214 (IQR 93, 230) minutes, than the open group, 93 (IQR 58, 143) minutes (p=0.01). There was no difference in median estimated blood loss (p=0.1). No patient required transfusion. There were no intraoperative complications. Median hospital stay was significantly shorter in the robotic partial cystectomy group, 1 (IQR 1, 2) day, than the open partial cystectomy group, 2 (IQR 2, 4) days (p=0.01). Median duration of catheterization and complications within 30days of surgery were not statistically different between the two groups. Median follow-up was 15.5 (IQR 8.6, 19.7) months for the robotic partial cystectomy group and 40.7 (IQR 6.5, 69.4) months for the open partial cystectomy group. Robotic partial cystectomy is safe, effective, and is associated with minimal morbidity when performed in properly selected patients for benign and malignant indications. When compared with open partial cystectomy, robotic partial cystectomy is associated with a longer operative time, but results in a shorter postoperative hospital stay.

Paraganglioma of the Urinary Bladder: A Series of 22 Cases in a Single Center.

Paraganglioma of the urinary bladder (PUB) is rare in bladder cancer, and currently, a study examining large number of cases from a single center has not been reported. This study aimed to present the clinical features, treatments, pathological characteristics, and prognosis of PUB. From January 2006 to June 2016, 22 patients were pathologically diagnosed with PUB in our hospital. Their clinical records, operative notes, pathological reports, and follow-up records were retrospectively reviewed. The incidence of PUB in patients with bladder cancer was 0.92%. The mean age at diagnosis was 49.8 ± 14.6 years (range, 16-76 years) and the male to female ratio was 1:1. Fourteen cases (63.6%) were functional. The common indicative symptoms included hematuria (36.4%), hypertension (31.8%), micturition syncope (27.3%), headache (18.2%), and palpitation (13.6%). All neoplasms were completely resected via transurethral resection of bladder tumor (TURBT), en bloc transurethral resection with thulium-yag laser, or partial cystectomy. Most PUB samples were positive for immunohistochemical (IHC) staining markers such as chromogranin A (CgA), Synaptophysin (Syn), CD56, and S-100 protein, while negative for IHC markers such as cytokeratins (CKs) and Melan A. According to pathological reports, 72.7% of PUB cases were at stage T2, 18.2% at T3, and 9.1% at T4. Two cases (9.1%) with metastasis were malignant. Two patients (9.1%) were lost during follow-up, and the remaining 20 patients were followed up for a period of 67.8 ± 38.5 months (range, 6-130 months). Among them, 16 patients (80%) recovered after the surgery, 1 patient (5%) died of natural causes. PUB recurred in 3 patients (15%), and 1 patient among them died of PUB. Despite the rarity, PUB should be suspected in patients with unexplained symptoms such as micturition syncope, hematuria, hypertension, headache, or palpitation. Surgery and adjuvant therapies are effective treatments for PUB. Compared with open surgery, laparoscopic partial cystectomy and robot-assisted laparoscopic partial cystectomy are advantageous in the treatment of PUB. Long-term follow-up is recommended for patients with PUB.

Robot-assisted laparoscopic partial cystectomy for urinary bladder paraganglioma

Pheochromocytoma is a rare neuroendocrine tumor that occurs in the urinary bladder. We reported a 56-year-old male patient with a history of bradycardia, dizziness, and hypertension provoked by micturition for 5 years. Magnetic resonance imaging discovered a 3.1 cm urinary bladder tumor over the right dome. High urinary catecholamines' level was also found. Robot-assisted laparoscopic partial cystectomy was performed smoothly without perioperative complications.

Robotic-assisted laparoscopic partial cystectomy for symptomatic urachal hamartoma.

We report a case of an urachal hamartoma in a 30-year-old African American woman. The urachal lesion was excised with a robotic-assisted laparoscopic partial cystectomy. Pathologic analysis revealed cysts, smooth muscle, and ciliated epithelium consistent with a hamartoma. The patient recovered without complication. This case highlights an unusual pathology that is infrequently reported following urachal remnant excision.

V1890 ROBOT-ASSISTED PARTIAL CYSTECTOMY FOR BLADDER CANCER OF A BLADDER DIVERTICULUM

You have accessJournal of UrologyOncology, Bladder Oncology1 Apr 2012V1890 ROBOT-ASSISTED PARTIAL CYSTECTOMY FOR BLADDER CANCER OF A BLADDER DIVERTICULUM Wooju Jeong, Quoc-Dien Trinh, Khurshid R. Ghani, Jesse D. Sammon, Jay Jhaveri, Shyam Sukumar, Ali Dabaja, Emil Kheterpal, Fred Muhletaler, Mani Menon, and Piyush K. Agarwal Wooju JeongWooju Jeong Detroit, MI More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Detroit, MI More articles by this author , Jesse D. SammonJesse D. Sammon Detroit, MI More articles by this author , Jay JhaveriJay Jhaveri Detroit, MI More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , Ali DabajaAli Dabaja Detroit, MI More articles by this author , Emil KheterpalEmil Kheterpal Detroit, MI More articles by this author , Fred MuhletalerFred Muhletaler Detroit, MI More articles by this author , Mani MenonMani Menon Detroit, MI More articles by this author , and Piyush K. AgarwalPiyush K. Agarwal Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2045AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of bladder diverticula is 1.7%, while the incidence of urothelial carcinoma within these diverticula ranges from 0.8 to 13%. In this video, we report our technique of robot-assisted partial cystectomy for urothelial cancer located within a bladder diverticulum. METHODS Our patient was a 64 year-old male who presented with a history of prostate cancer on active surveillance. He underwent a cystoscopy for increasing post-void residual, which revealed an incidental bladder tumor within a diverticulum. This tumor turned out to be a high-grade pTa lesion. A transperitoneal robot-assisted laparoscopic approach was used to mobilize the bladder. The bladder lesion was marked with a hook cautery circumferentially. Simultaneous cystoscopic monitoring was performed to ensure a margin of resection of 2 cm around the lesion. Bladder reconstruction and bilateral pelvic lymph node dissection were subsequently completed. RESULTS Our console time was 5 hours with an estimated blood loss of 50 mL. No JP drain was placed. There were no intra or post-operative complications. Diet was resumed on postoperative day 1 and the patient was discharged on postoperative day 1. Pathological examination revealed an urothelial carcinoma pTaN0Mx with low grade and negative surgical margins. He is doing well with no sign of recurrence at three months of follow-up. CONCLUSIONS Robot-assisted laparoscopic partial cystectomy is technically feasible and represents an alternative to open and conventional laparoscopic approaches. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e762-e763 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wooju Jeong Detroit, MI More articles by this author Quoc-Dien Trinh Detroit, MI More articles by this author Khurshid R. Ghani Detroit, MI More articles by this author Jesse D. Sammon Detroit, MI More articles by this author Jay Jhaveri Detroit, MI More articles by this author Shyam Sukumar Detroit, MI More articles by this author Ali Dabaja Detroit, MI More articles by this author Emil Kheterpal Detroit, MI More articles by this author Fred Muhletaler Detroit, MI More articles by this author Mani Menon Detroit, MI More articles by this author Piyush K. Agarwal Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

UP-1.80: Robotic-assisted laparoscopic radical cystectomy (RARC) with extracorporeal urinary diversion and robotic-assisted laparoscopic partial cystectomy (RAPC)

The goals of managing bladder cancers are to control cancer, as well as to improve the quality of life including reducing pain and skin incision and also urinary diversions are essential parts of bladder cancer patients. The aims of this study are to present the clinical outcomes of bladder cancer patients who underwent robotassisted laparoscopic radical cystectomy (RARC) with extracorporeal ileal conduit and robot-assisted laparoscopic partial cystectomy(RAPC).

31 The initial experience of robotic-assisted laparoscopic partial cystectomy in urachal diseases

31 The initial experience of robotic-assisted laparoscopic partial cystectomy in urachal diseases

Initial Experience with Robotic-Assisted Laparoscopic Partial Cystectomy in Urachal Diseases

PurposeIn this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases.Materials and MethodsTwo men and two women with a mean age of 51.5±9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0° robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl.ResultsThe mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus.ConclusionsOur initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.

Robotic assisted laparoscopic partial cystectomy and urachal resection for urachal adenocarcinoma

Standard treatment for urachal adenocarcinomas is open partial cystectomy and urachal resection; however, minimally invasive surgical approaches including laparoscopic and recently described robotic assisted laparoscopic partial cystectomy and urachal resection is feasible with potential less morbidity. A case of robotic assisted partial cystectomy and urachal resection for urachal adenocarcinoma is presented. Few articles in the literature have being published describing this technique and to the best of our knowledge, this is the largest and potentially most complex case approached in such a manner. A 55 years old African American male presented with hematuria and mucosuria, cystoscopy demonstrated a tumor involving the dome of the bladder. Transurethral biopsy confirmed a urachal adenocarcinoma. Further studies revealed a negative metastatic evaluation. Preoperative abdominal/pelvic CT imaging revealed an enhancing mass extending from the inferior level of the umbilicus to the dome of the bladder. A total of 6 laparoscopic ports were used. The robotic assisted laparoscopic dissection was started at the level of the umbilicus, dissecting lateral to the right and left medial umbilical ligaments up until the dome of the bladder. A simultaneous cystoscopy with transillumination to define the bladder boundaries of this mass, with robotic assisted laparoscopic opening of the bladder, with the entire mass (including bladder component) excised and sent for frozen pathology for margin evaluation. After specimen extraction, the bladder was closed in two layers. Total surgery time was 300 minutes and intra-operative blood loss was 150cc. Final pathology reported a pT2N0Mx adenocarcinoma with negative margins and negative pelvic lymph nodes. Patient was started on clear liquids on postoperative day 2 and on regular diet on postoperative day 3. He was discharged on postoperative day 4. A cystogram perfomed on postoperative day 7 revealed a good bladder capacity (350 cc) and no leakage was identified. Robotic assisted partial cystectomy and urachal resection for urachal adenocarcinoma of the bladder is feasible even in challenging cases. This surgical approach is less morbid in terms of postoperative pain and cosmesis when compared to the open standard approach. The postoperative recovery is faster; however, application of oncological principles and comfort with laparoscopic and robotic surgery is needed prior to attempting such challenging cases. [Video - Available at: www.brazjurol.com.br/videos/september_october_2009/Spiess_609].

Robot-Assisted Laparoscopic Partial Cystectomy and Diverticulectomy: Initial Experience of Four Cases

We report our initial experience with four cases of robot-assisted laparoscopic partial cystectomy and diverticulectomy performed between June 2005 and August 2007. The series consisted of three male patients and one female with a mean age of 64 years (range 36-77 years). In each case, a transperitoneal laparoscopic approach was used to mobilize the bladder. Next the bladder lesion was scored circumferentially cystoscopically with a Collings knife. The remainder of the excision and bladder reconstruction was performed with the da Vinci robot. Mean operative time was 194 minutes with a mean blood loss of 35 mL. The urethral catheter was removed between 5 and 14 days following a normal cystogram. There were no significant complications. Postoperative hospital stay was 2 to 3 days. Robot-assisted laparoscopic partial cystectomy and diverticulectomy are technically feasible and represent an alternative to open and conventional laparoscopic approaches.