Robotic Partial Cystectomy via a Transvesical Approach for Management of Bladder Cancer Within a Diverticulum

Abstract

Clinical History:

Endoscopic management of extensive isolated tumor burden within a bladder diverticulum is technically difficult.

Physical Exam:

The patient presented with gross hematuria.

Diagnosis:

We describe the case of a 70-year-old male with history of high-grade T1 nonmuscle invasive bladder cancer who was referred for management of extensive tumor burden found within a left lateral wall bladder diverticulum.

Intervention:

We describe our approach for robotic partial cystectomy via a transvesical approach for management of tumor burden within a bladder diverticulum. After a vertical cystotomy was made along the midline at the dome of the bladder, the left lateral wall diverticulum was identified. Electrocautery was used to circumferentially incise the bladder diverticulum until perivesical fat was encountered. The opening of the bladder diverticulum was closed with braided absorbable suture to reduce the risk of tumor spillage. Once the diverticulum was dissected free off the perivesical fat, the bladder defect was closed in two layers using braided absorbable suture. The cystotomy was closed in a two-layer running fashion and was confirmed to be water-tight.

Follow-Up/Outcomes:

Operative time was 91 minutes and estimated blood loss was 25 mL. There were no intraoperative complications, and the patient was discharged on the same day with a Foley catheter in place. Postoperative pathology demonstrated high-grade Ta nonmuscle invasive bladder cancer. The patient had a successful trial of void 2 weeks postoperatively and has not experienced any postoperative complications. Robotic partial cystectomy via a transvesical approach may be utilized for management of tumor burden within a bladder diverticulum.

Patient Consent Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the institutional review board at Temple University (protocol number 20793).

M.L., C.M., and J.J. have no conflicts of interest to disclose. D.E. is founder of Melzi corp and a consultant for Intuitive Surgical and Johnson and Johnson

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Runtime of video: 4 mins 15 secs