#306 Single port urinary diversion in a hostile abdomen- Dr. Neerja Tillu
This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.
From the entry: Abstract: Robot-assisted intracorporeal urinary diversion has been shown to be a feasible operation. However, it can be technically challenging in an abdomen complicated by previous surgery and radiation. Inserting multiple ports can result in bowel injury during entry. In such cases, a single port (SP) entry can minimize its chances. A 55-year-old lady had a history of cervical cancer treated with radiation 15 years back and previous hospitalization for stroke 3 years back. During her hospitalisation, she developed a decubitus ulcer that led to a diverting colostomy and was catheterized for bilateral hydronephrosis secondary to contracted bladder. For over a year she endorsed discomfort and frequent UTIs secondary to chronic catheterization.
She was scheduled for a SP intracorporeal ileal conduit. The colostomy was taken down and an SP access port was inserted through the colostomy site. The robot was side docked, and adhesions were taken down. Both ureters were dissected, and 15 cm of ileum was harvested. A Wallace type-2 uretero- ureteral anastomosis was performed and stented. The ureteral anastomosis was sutured to the open end of the ileal conduit and the other end was matured as stoma. The colostomy was exteriorized through the previous incision.
Features such as camera adjust/control/cobra mode, virtual navigator, the relocate pedal and floating dock allow troubleshooting in SP and enable outcomes like multiport surgery. Our experience demonstrates that SP robotic surgery can be a safer option for complex reconstruction surgeries in a hostile abdomen.