#358 R. A. Radical Cystectomy with Intracorporeal modified Pitcher-pot neobladder- Dr. Sumit Agrawal

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans at 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: Full Title: Our initial experience with Robot assisted Radical Cystectomy with Intracorporeal modified Pitcher-pot neobladder

Introduction: Robot assisted Radical Cystectomy has become a choice for surgical management of muscle invasive bladder cancer. With robot assistance intracorporeal urinary diversion (neobladder) can be done by a minimally invasive method. At our center, we do modified pitcher pot type of neobladder. So, with this video we share our experience.

Methods: Standard Robotic Radical cystectomy with bilateral pelvic lymph node dissection was done. For neobladder formation, 54-60 cm-terminal ileum segment was selected, 20 cm proximal to the ileocecal junction. Bowel is detubularised along U configuration with U shaped flap which will act as a bladder neck and neourethra after tubularisation of flap (Modified pitcher pot technique). Posterior layer is sutured. Following this, U shaped flap is tubularised and anastomosed to native urethra over 18 Fr foleys catheter. 20 Fr SPC placed through anterior layer. After that, bilateral uretero-ileal anastomosis is done with afferent limb over 6 Fr infant feeding tubes.

Results: Our surgical time was 5 hour 30 minutes to 6 hours. Post-operative period was uneventful. Drain, bilateral ureteric stent, suprapubic catheter and perurethral catheter were removed on POD 7, POD 15, POD 15 and POD 21 respectively. Patient had mild SUI post catheter removal and good continence after 1 month.

Conclusion: Robot assisted Radical Cystectomy with Intracorporeal modified Pitcher-pot neobladder is equivalent to open radical cystectomy is terms outcomes with good magnified visualization for anastomosis and small incision for early recovery and less post-operative pain.

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