Robot assisted laparoscopic cystoprostatectomy with ultrapreservation and intracorporeal neobladder

• Robot-assisted laparoscopic cystoprostatectomy has been described years ago, but its overall benefits remain questioned. • We present the case of a 59-year old male who underwent a fully robot-assisted radical cystectomy with intracorporeal urinary diversion and ultrapreservation • At 6th month follow-up, there were no major (Clavien >2) postoperative complications, and the patient had fully restored urinary continence Radical cystectomy remains the gold standard for muscle invasive bladder cancer. Though described many years ago, laparoscopic robot assisted approach remains controversial due to its steep learning curve and long operative time, despite the proven benefits of minimally invasive surgery. We describe our totally intracorporeal approach for bladder cancer. We present the case of a 59-year old male with high-grade muscle invasive bladder cancer who underwent a minimally invasive technique. We ruled out a coexisting prostate cancer. After identification and isolation of both ureters, followed by an extended pelvic lymphadenectomy, posterior dissection begins, where neurovascular bundle preservation starts. Anterior dissection spares the endopelvic fascia and dorsal venous complex. After completion of the cystectomy, ileo-urethral anastomosis is performed. By isolating 40cm of small bowel we constructed the neobladder in ‘Bordeaux’s’ technique. Check for leakage with 60mL of saline and any extra suturing is made before finishing. A 19Fr drainage catheter is placed in the small pelvis. Mean surgery time was 420 minutes and the estimated blood loss was 300mL. Patient was discharged at postoperative day 6 without any perioperative complications. Ureteral stents were removed in outpatient care 14 days later and urethral Foley catheter 7 days after. Six month follow-up proves full restoration of urinary continence and no major (Clavien >2) postoperative complications. Minimally invasive with totally intracorporeal approach after radical cystectomy is feasible and effective in terms of urinary continence and oncological outcomes.