Transvesical Versus Transabdominal - Which is the Best Approach to Bladder Diverticulectomy Using the Single Port Robotic System?

OBJECTIVEApplication of the Single Port (SP) robotic platform [Intuitive] is expanding. Using 2 illustrative examples of bladder diverticula (BD) resulting from bladder outflow obstruction (BOO), we describe in this video our techniques utilizing SP to treat BD via Extravesical (EV#1) and Transvesical (TV#2) approaches. METHODSIn EV#1, a 56-year old, with BOO due to benign prostate enlargement (BPE) of a 30 mL prostate, and a 5 cm BD, was treated with RABD-SP. A subumbilical SP access was used to approach and excise the BD in an EV fashion. The BPE was treated with Rezum. A 16 Fr urethral catheter was placed. In TV#2, a 67-year old, with urinary retention due to a 55 mL BPE and a 6 cm BD in the right posterolateral aspect adjacent the ureteric orifice, was treated with RABD-SP using a Gelport (no additional assistant ports). An open cut-down was performed onto a prefilled bladder and secured onto the abdominal wall with stay sutures. After draining the bladder, a Gelport was introduced into the bladder for SP docking with pneumo-vesical insufflation. Intravesical (inside-out) excision of the BD was performed with protection of the adjacent right ureteric orifice with an open access ureteral catheter. Utilizing the TV access, a simple prostatectomy was performed. A 22 Fr, 3-way catheter was placed at the end. RESULTSFor EV#1 and TV#2, estimated blood losses were 5 and 100 mL, length stay was 1 day in both, without any immediate perioperative complications. Both patients had successful trials of void on postoperative day 7 and 9, respectively. CONCLUSIONRABD-SP can be customized to treat BD, via transabdominal (extravesical) or transvesical (with bladder pneumo-insufflation) approaches, and combined with different BOO treatments (Rezum or simple prostatectomy, for instance), in a patient-specific personalized manner.