Robot-assisted laparoscopic bladder diverticulectomy: adaptation of techniques for a variety of clinical presentations

Bladder Cancer

Urology. 2020 Aug 7:S0090-4295(20)30957-2. doi: 10.1016/j.urology.2020.07.044. Online ahead of print.


OBJECTIVES: To report our experience in robot-assisted laparoscopic bladder diverticulectomy (RALBD) with a focus on technical modifications aimed at accommodating for differences in anatomy and pathologies.

PATIENTS AND METHODS: A prospective database was maintained for 20 patients who had RALBD at our institution. Clinicopathological and follow-up details including concomitant procedure performed were reviewed for each case. Two patients had intra-diverticular urothelial carcinoma (IDUC) refractory to endoscopic and intravesical management. The dissection of the diverticular neck was performed utilising one of the three approaches: extravesical (8 of 20 patients), transvesical (11) and trans-diverticular (1). Pre and postoperative PVR and IPSS were compared using paired-sample t test. In addition, 6 patients underwent open bladder diverticulectomy (OBD) during the period and their perioperative parameters were compared with the RALBD group.

RESULTS: The median age was 66 and the average BMI was 27.2. Thirteen patients underwent major concomitant urological procedures. Mean operative duration was 184 minutes with average length of hospital stay at 2.1 days. One Clavien 3 complication was encountered. There were significant improvements in pre & post-operative PVR (425 to 49 ml, p = 0.000) and IPSS (19 to 6, p = 0.033). When compared to OBD, RALBD is associated with reductions in blood loss (100 ml vs. 283 ml, p = 0.003).

CONCLUSION: Despite the wide variability in clinical presentations, RALBD is associated with minimal surgical morbidity and good perioperative outcomes. It can be safely performed in conjunction with other major urological procedures in the pelvis.