How is a neobladder born? Ves.Pa.: ‘From lab to fab’

VE05 How is a neobladder born? Ves.Pa.: 'From lab to fab' Dal Moro F., Valotto C., Zattoni F., Filiberto Zattoni Universita' di Padova - Azienda Ospedaliera, Dept. of Surgery, Oncology and Gastroenterology - Urology, Padova, Italy INTRODUCTION & OBJECTIVES: Recent studies have demonstrated the feasibility of robotic intracorporeal urinary diversion after radical cystectomy. However, to improve efficiency and reduce operating time, several modifications to standard open configurations have been used. Starting from the analysis of the peculiar features and the long-term functional outcomes of "VIP" (Vescica Ileale Padovana), we have designed a novel robotic intracorporeal ileal orthotopic neobladder. Here we present a detailed description of the process of creation of "Ves.Pa." (lat. Vesica Patavina, - Paduan Bladder), starting from in-lab preliminary tests until the final realisation in human. MATERIAL & METHODS: The anatomical and technical feasibility of "Ves.Pa." was tested in silico, ex vivo and in a robotic pelvic model. During robotic tests, procedures were recorded to identify possible improvements in operating times. Finally, after an accurate step-by-step planning, we performed the procedure in human after robotic radical cystectomy. RESULTS: After initial evaluation of the anatomical feasibility of the technique, its practicability was confirmed during ex vivo tests. Tests on our robotic pelvic model confirmed the feasibility of the technique, and some details to improve its time efficiency were identified. The creation of totally intracoporeal orthotopic neobladder "Ves.Pa." after robotic radical cystectomy has proved to be safe, easy-to-perform and efficient (operative time). Preoperative in-lab tests have proved to be extremely useful to help in planning and creating "Ves.Pa." in human. CONCLUSIONS: Despite the increasing use of robotic radical cystectomy, most urological departments do not perform "ideal" intracorporeal urinary diversion, due to perceived technical difficulties in reconfiguring the ileum and operating times in comparison with open surgery. We demonstrated how a novel robotic totally intracorporeal orthotopic neobladder could be designed, in-lab tested and then successfully in-vivo realised. Further clinical studies are needed to confirm these findings.

Eur Urol Suppl 2016; 15(7):308