Technique for a Modified Florence Robot-Assisted Intracorporeal Neobladder (FloRIN) Creation

Abstract

Introduction:

In this video, we demonstrate a modified technique for a Florence robot-assisted intracorporeal neobladder (FloRIN) creation. This technique utilizes an asymmetrical U-shaped portion of ileum to create a spherical-shaped neobladder with a pseudo-neo-bladder neck, with the aim to optimize postoperative continence. Here we report our technique with a case-based presentation. ¹

Methods:

The patient for this case is a 66-year-old male with a history of coronary artery disease, nephrolithiasis, and inguinal hernia repair. He presented with gross hematuria, multiple bladder tumors on cystoscopy, and T2 urothelial carcinoma and carcinoma in situ on transurethral resection of bladder tumor. The patient underwent neoadjuvant chemotherapy and then elected to proceed with robotic-assisted radical cystectomy with pelvic lymph node dissection and intracorporeal neobladder creation.

In this video, we depict the steps of the modified FloRIN, beginning after the radical cystoprostatectomy portion of the case, with robotic port and instrument setup for the neobladder creation. We demonstrate the following steps: urethral anastomosis, stapling off an asymmetrical U-shaped 45 cm segment of bowel to be utilized for the neobladder, a side-to-side bowel anastomosis with the 60 mm Endo GIA stapler, detubularization of the closed bowel segment along the antimesenteric side, creation of the posterior plate of the neobladder, closure of the anterior portion of the neobladder to create a spherical shape, and bilateral ureteral reimplantation using the Politano-Leadbetter method (see Fig. 1).

FIG. 1.

Illustration of modified FloRIN creation. 1. Posterior neobladder creation. 2. Anterior neobladder creation. 3. Ureteral reimplantation. 4. Completed neobladder.

Results:

We have performed this technique in approximately 25 patients at our institution thus far, with short- and long-term outcomes evaluated on an ongoing basis. For this patient, operative time was 7 hours and 30 minutes, estimated blood loss was 150 cc, he did not require narcotics after postoperative day 0, had a bowel movement by postoperative day 3, and was discharged by postoperative day 4. Final Pathology: ypT0N0, prostate adenocarcinoma GG1 pT2N0. 3-month postoperative functional outcomes: no longer self-catheterizing, three to four pads during the day for leakage, one pad overnight, no return of erectile function.

Conclusions:

This video depicts a modified FloRIN technique with associated medical illustrations. The FloRIN technique may be associated with improved continence rates and decreased need for catheterization in comparison to the Studer or Hautmann neobladders. Data regarding long-term postoperative functional outcomes are being collected.

Author Disclosure Statement:

The authors have no financial disclosure or conflicts of interest with the material presented in this presentation.

Patient Consent Statement:

Author(s) have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.

Runtime of video: 7 min 25 sec.