- Email: [email protected]
V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
e61
with a 60mm stapler on the antimesenteric aspect. The ileocecal valve and the efferent limb are plicated to increase the outflow resistance. The efferent limb is now extracted and the stoma created at the umbilical site. RESULTS: There were no intraoperative complications and all procedures (n¼10) were successfully completed robotically. Median operative times were 60 min for cystectomy, 65 min for PLND, 45 min for repositioning/re-docking and 210 min for pouch construction. The median overall operative time was 365 (295-540) min. No patients were transfused. Median hospital stay was 9 days. 30-day complication rate was 40%. There were no grade 3 or 4 complications. At 3-month followup urodynamics demonstrated a mean maximum capacity of 270mL without ureteral reflux and minimal urine residual; 9 patients (90%) reported full continence. No patient died. CONCLUSIONS: Robotic Indiana pouch can be safely performed, completely intracorporeally. This technique provides a minimally-invasive, time efficient approach with acceptable complication rates. Patients undergoing radical cystectomy can now be offered all types of urinary diversions robotically. Source of Funding: none
V1-02
Source of Funding: None
NOVEL TECHNIQUE FOR THE RECONSTRUCTION OF REFRACTORY PROSTATIC URETHRAL STENOSIS ASSOCIATED WITH MEDIAL THIGH FISTULA FOLLOWING BRACHYTHERAPY.
Robotics-Bladder/Reconstruction Video Friday, May 6, 2016
10:00 AM-12:00 PM
V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY Andre Luis de Castro Abreu*, Los Angeles, CA; Giuseppe Simone, Roma, Italy; Sameer Chopra, Los Angeles, CA; Mariaconsiglia Ferriero, Rocco Papalia, Roma, Italy; Nariman Ahmadi, Los Angeles, CA; Riccardo Mastroianni, Roma, Italy; Daniel Park, Andre Berger, Los Angeles, CA; Salvatore Guaglianone, Roma, Italy; Rene Sotelo, Los Angeles, CA; Michelle Gallucci, Roma, Italy; Monish Aron, Inderbir Gill, Mihir Desai, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Continent cutaneous diversion is an option for patients undergoing cystectomy. Herein we report our experience of 10 consecutive patients who underwent completely intracorporeal robotic Indiana Pouch construction following robotic cystectomy. METHODS: Surgical steps: Robotic cystectomy and pelvic lymph node dissection (PLND) are performed with a 6-trocar access. Robot is undocked and specimen extracted from the left lateral port. Both left side ports are closed and three additional ports are placed. Table is rotated 45 degree to left and the robot is re-docked on right side. Replicating open techniques: 12 cm of distal ileum and 30cm of right colon are isolated; side to side stapled ileocolonic anastomosis is performed; colonic segment is detubularized along the antimesenteric tenia up to 3cm distal to the ileocecal valve and U folded. The medial aspect of the folded colon is sewn. Ureterocolonic anastomoses are performed on the posterior aspect of the pouch. Bilateral J stents are placed in ureters and secured to a 24-Fr hematuria catheter inserted via the appendiceal orifice. After closing the lateral aspect of the pouch, a Foley catheter is inserted via the umbilical port and through efferent ileal limb and placed into the colonic pouch. The efferent limb is tapered
Temitope Rude, MD*, Kiranpreet Khurana, MD, Jamie Levine, MD, Lee Zhao, MD, New York, NY INTRODUCTION AND OBJECTIVES: Urethral stenosis and fistulae in the radiated patient are difficult reconstructive challenges. While posterior urethroplasty via the perineal approach can be performed for isolated urethral stenosis, prostatic fistulae can be difficult to access perineally. We present a novel technique for a robot assisted reconstruction in a patient with prostatic urethral stenosis and fistula between prostate and the thigh. METHODS: The patient is a 69 year old man with a history of prostate cancer treated with brachytherapy 15 years prior to presentation which caused prostatic urethral stenosis and prostato-membranous urethral stricture. After failed repeated endoscopic management, he developed a fistula between the prostatic urethra and medial thigh managed with suprapubic cystotomy and intravenous antibiotics. To salvage the native bladder in this active and otherwise healthy man with a normal bladder capacity, we undertook a salvage prostatectomy with excision of urethral stricture via a combined robotic and perineal approach. We utilized fluorescence visualization and an end-to-end anastomosis sizer in the rectum to achieve a safe robotic dissection. A prostatectomy was performed to resect the fistula to the thigh. To create a tension free anastomosis, a perineal approach was used to mobilize the urethra and the diseased urethra was excised. The urethra was passed into the pelvis after the paired corporal bodies were split. The vesicourethral anastomosis was completed in a running fashion. For coverage of prostate to thigh fistula, a left rectus abdominus flap with plastic surgery. The flap was split vertically. One portion was passed posterior to the bladder and through the perineal incision to buttress the ventral surface of the urethra in preparation for future transcorporal artificial urinary sphincter (AUS) placement. The second portion was placed anterior to the urethra to protect the anastomosis. RESULTS: The foley catheter was removed one month post-surgery. At two month follow-up, the patient had no complications. Cystoscopy indicates a patent vesicourethral anastomosis. AUS placement is scheduled for 4 months after surgery for incontinence.
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
e61
with a 60mm stapler on the antimesenteric aspect. The ileocecal valve and the efferent limb are plicated to increase the outflow resistance. The efferent limb is now extracted and the stoma created at the umbilical site. RESULTS: There were no intraoperative complications and all procedures (n¼10) were successfully completed robotically. Median operative times were 60 min for cystectomy, 65 min for PLND, 45 min for repositioning/re-docking and 210 min for pouch construction. The median overall operative time was 365 (295-540) min. No patients were transfused. Median hospital stay was 9 days. 30-day complication rate was 40%. There were no grade 3 or 4 complications. At 3-month followup urodynamics demonstrated a mean maximum capacity of 270mL without ureteral reflux and minimal urine residual; 9 patients (90%) reported full continence. No patient died. CONCLUSIONS: Robotic Indiana pouch can be safely performed, completely intracorporeally. This technique provides a minimally-invasive, time efficient approach with acceptable complication rates. Patients undergoing radical cystectomy can now be offered all types of urinary diversions robotically. Source of Funding: none
V1-02
Source of Funding: None
NOVEL TECHNIQUE FOR THE RECONSTRUCTION OF REFRACTORY PROSTATIC URETHRAL STENOSIS ASSOCIATED WITH MEDIAL THIGH FISTULA FOLLOWING BRACHYTHERAPY.
Robotics-Bladder/Reconstruction Video Friday, May 6, 2016
10:00 AM-12:00 PM
V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY Andre Luis de Castro Abreu*, Los Angeles, CA; Giuseppe Simone, Roma, Italy; Sameer Chopra, Los Angeles, CA; Mariaconsiglia Ferriero, Rocco Papalia, Roma, Italy; Nariman Ahmadi, Los Angeles, CA; Riccardo Mastroianni, Roma, Italy; Daniel Park, Andre Berger, Los Angeles, CA; Salvatore Guaglianone, Roma, Italy; Rene Sotelo, Los Angeles, CA; Michelle Gallucci, Roma, Italy; Monish Aron, Inderbir Gill, Mihir Desai, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Continent cutaneous diversion is an option for patients undergoing cystectomy. Herein we report our experience of 10 consecutive patients who underwent completely intracorporeal robotic Indiana Pouch construction following robotic cystectomy. METHODS: Surgical steps: Robotic cystectomy and pelvic lymph node dissection (PLND) are performed with a 6-trocar access. Robot is undocked and specimen extracted from the left lateral port. Both left side ports are closed and three additional ports are placed. Table is rotated 45 degree to left and the robot is re-docked on right side. Replicating open techniques: 12 cm of distal ileum and 30cm of right colon are isolated; side to side stapled ileocolonic anastomosis is performed; colonic segment is detubularized along the antimesenteric tenia up to 3cm distal to the ileocecal valve and U folded. The medial aspect of the folded colon is sewn. Ureterocolonic anastomoses are performed on the posterior aspect of the pouch. Bilateral J stents are placed in ureters and secured to a 24-Fr hematuria catheter inserted via the appendiceal orifice. After closing the lateral aspect of the pouch, a Foley catheter is inserted via the umbilical port and through efferent ileal limb and placed into the colonic pouch. The efferent limb is tapered
Temitope Rude, MD*, Kiranpreet Khurana, MD, Jamie Levine, MD, Lee Zhao, MD, New York, NY INTRODUCTION AND OBJECTIVES: Urethral stenosis and fistulae in the radiated patient are difficult reconstructive challenges. While posterior urethroplasty via the perineal approach can be performed for isolated urethral stenosis, prostatic fistulae can be difficult to access perineally. We present a novel technique for a robot assisted reconstruction in a patient with prostatic urethral stenosis and fistula between prostate and the thigh. METHODS: The patient is a 69 year old man with a history of prostate cancer treated with brachytherapy 15 years prior to presentation which caused prostatic urethral stenosis and prostato-membranous urethral stricture. After failed repeated endoscopic management, he developed a fistula between the prostatic urethra and medial thigh managed with suprapubic cystotomy and intravenous antibiotics. To salvage the native bladder in this active and otherwise healthy man with a normal bladder capacity, we undertook a salvage prostatectomy with excision of urethral stricture via a combined robotic and perineal approach. We utilized fluorescence visualization and an end-to-end anastomosis sizer in the rectum to achieve a safe robotic dissection. A prostatectomy was performed to resect the fistula to the thigh. To create a tension free anastomosis, a perineal approach was used to mobilize the urethra and the diseased urethra was excised. The urethra was passed into the pelvis after the paired corporal bodies were split. The vesicourethral anastomosis was completed in a running fashion. For coverage of prostate to thigh fistula, a left rectus abdominus flap with plastic surgery. The flap was split vertically. One portion was passed posterior to the bladder and through the perineal incision to buttress the ventral surface of the urethra in preparation for future transcorporal artificial urinary sphincter (AUS) placement. The second portion was placed anterior to the urethra to protect the anastomosis. RESULTS: The foley catheter was removed one month post-surgery. At two month follow-up, the patient had no complications. Cystoscopy indicates a patent vesicourethral anastomosis. AUS placement is scheduled for 4 months after surgery for incontinence.