Objective: The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). Materials and methods: Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. Results: Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5–9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90–395) ml. The median (IQR) OT was 112.5 (83.7–133.7) min and median (IQR) EBL was 25.8 (0–50) ml. The median (IQR) LOS was 7 (4.7–9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. Conclusions: RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.

Robotic bladder diverticulectomy: step-by-step extravesical posterior approach - technique and outcomes

Cacciamani, Giovanni
Writing – Original Draft Preparation
;
De Luyk, Nicolò
Membro del Collaboration Group
;
De Marco, Vincenzo
Membro del Collaboration Group
;
Sebben, Marco
Membro del Collaboration Group
;
Bizzotto, Leonardo
Membro del Collaboration Group
;
De Marchi, Davide
Membro del Collaboration Group
;
Cerruto, Maria Angela
Supervision
;
Siracusano, Salvatore
Membro del Collaboration Group
;
Benito Porcaro, Antonio
Membro del Collaboration Group
;
Artibani, Walter
Supervision
2018-01-01

Abstract

Objective: The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). Materials and methods: Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. Results: Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5–9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90–395) ml. The median (IQR) OT was 112.5 (83.7–133.7) min and median (IQR) EBL was 25.8 (0–50) ml. The median (IQR) LOS was 7 (4.7–9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. Conclusions: RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.
bladder diverticula; bladder diverticulum; bladder outlet obstruction; robot-assisted bladder diverticulectomy; robot-assisted surgery; Aged; Blood Loss, Surgical; Cystography; Diverticulum; Feasibility Studies; Humans; Length of Stay; Middle Aged; Operative Time; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Urinary Bladder; Urologic Surgical Procedures
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/997800
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