AB013. Robotic-assisted laparoscopic cysto-prostatectomy with bilateral pelvic lymph node dissection and extra-corporeal ileal conduit urinary diversion: initial experience in Ireland

Background: Robot-assisted procedures are expanding rapidly in minimally invasive urologic surgery. We demonstrate the use of da Vinci Xi dual console system for robotic-assisted laparoscopic radical cysto-prostatectomy (RALRCP) with bilateral pelvic lymph node dissection (PLND) and extra-corporeal ileal conduit diversion (ICUD).

Methods: We assembled video footage from the above procedure from the patient who underwent RALRCP and PLND following neo-adjuvant chemotherapy for muscle invasive urothelial cancer of the bladder.

Results: We demonstrate trocar placement and a robotic-arm docking strategy for this procedure. Surgical steps involved in RALRCP and PLND are shown. The bladder is placed on traction using the fourth arm, and the avascular planes of dissection, including the space of Retzius and the para-vesical spaces, are shown. The specimen was extracted through the 6-cm-sized McBurney’s incision in the right iliac fossa. The ICUD was achieved through a removal site of a specimen by an extracorporeal technique. The total operative time was 360 minutes and the estimated blood loss was 400 mL. The pathologic examination showed a stage T2, N1 with negative surgical margins.

Conclusions: RALRCP and PLND can be an alternative to the open technique. We are the first group to perform RALRC in Ireland and to report on our technique and outcome.

Keywords: Robotic; laparoscopic; cysto-prostatectomy; pelvic lymph node dissection (PLND); ileal conduit