Category: Robotic Surgery: Lower Tract - Malignant
Introduction & Objective : Bladder divertiuli has indication for surgery in cases of bladder out obstruction, urinary tract infection or if it contains tumors. Bladder cancer in a bladder diverticuli has always been a concern for treatment. We demonstrate our technique for the management of complex cases.
Methods : A 63 y/o male patient underwent work up for microhematuria in another institution. Abdomino pelvic CT scan showed a bladder diverticuli at the dome with a filling defect. Cystoscopy showed a papillary tumor of 1.5 cm inside of the bladder diverticuli. Urine cytology was negative. Random bladder bladder biopsies were negative for malignancy. Patient was offered a robotic assisted partial cystectomy. Patient was placed in lithotomy position. Cystoscope tower was connected to the Tilepro of the robotic system. Tilepro was used to see cystoscope images in the console.Flexible cystoscope was passed under direct vision. We proceeded to use external depression in the bladder wall. This depression was evaluated in real time with the use of the cystoscope. This procedure was repeated in order to establish adequate margins. Incision of the serosa, perivesical fat and detrussor muscle was done progressively. Intermitent evaluation of margins were done while we continued with the dissection. This dissection continued until protrusion of the bladder mucose was identified. Stay sutures were placed. Endogia was used to excise and isolate the bladder diverticuli. Bladder diverticuli was placed on the bag. Line of suture in the bladder was cut and send for frozen section. Bladder was closed in two layers. Bilateral extended pelvic lymphadenectomy was done.
Results : Patient did well postoperatively. Console time was 105 min. Estimate blood loss is 10ml. Frozen section of the margin was negative. Patient was discharge home the next day after surgery. Pathology showed a low grade transitional cell carcinoma with no evidence of metastasis at the lymph nodes (0/16). Patient has no evidence of recurrence for the past year.
Conclusions : Robotic assisted partial cystectomy is a valid and safe option to treat bladder cancer in a diverticuli
University of Puerto Rico
Bayamon, Not Applicable, Puerto Rico