Robotic-assisted radical cystectomy with nerve-sparing and mesentery-sparing techniques and intracorporeal modified Y-shaped orthotopic neobladder

• Innovative Surgical Technique: This study presents an advanced strategy for robotic-assisted radical cystectomy (RARC), combining nerve-sparing and mesentery-sparing techniques to enhance oncological control and postoperative functional outcomes. • Nerve-Sparing Approach: The technique enables complete preservation of the neurovascular bundles, facilitating early return of urinary continence and recovery of erectile function. • Mesentery-Sparing Urinary Diversion: This approach, previously described by our group in intracorporeal urinary diversion (ICUD), preserves ileal vascular integrity and reduces the risk of ischemia and postoperative complications. • Oncological Safety and Functional Recovery: The patient achieved negative surgical margins (pT2b pN0), regained full daytime and nighttime continence, and recovered erectile function sufficient for intercourse within one month after surgery. • Potential for Broader Clinical Adoption: The study highlights the value of meticulous robotic dissection and illustrates how advanced surgical techniques can improve functional outcomes in younger patients undergoing radical cystectomy. Bladder cancer in patients under 40 years represents 1% to 2.4% of all cases. In younger patients, radical cystectomy with pelvic lymph node dissection and urinary diversion raises significant concerns about urinary and sexual function preservation. This video/article describes our technique for preserving ileal vascularization (mesentery-sparing) combined with a retrograde nerve-sparing approach in robotic-assisted radical cystectomy (RARC). We present a 39-year-old male who underwent RARC using a standard transperitoneal technique with two modifications: nerve-sparing (NS) and mesentery-sparing (MS). Intrafascial retrograde dissection ensured complete preservation of the neurovascular bundle (NVB). A 60-cm ileal segment was isolated for neobladder reconstruction using the MS technique. The neobladder was created by detubularizing the ileal segment and suturing it into a modified Y configuration. Pathology revealed high-grade invasive urothelial carcinoma with carcinoma in situ. Margins were negative, and all 28 lymph nodes were disease-free (pT2b pN0). Postoperatively, the patient achieved daytime and nighttime continence without post-void residual and had erections sufficient for intercourse one month after surgery. RARC incorporating advanced NS and MS techniques provides effective oncological control with favorable functional outcomes. Preservation of vascular integrity in the ileum and neurovascular bundles is critical for achieving optimal continence and early recovery of erectile function. Our results highlight the importance of meticulous robotic dissection. Further studies are needed to validate these findings and broaden the application of these techniques.