Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration

Objective: Robotic intracorporeal neobladder reconstruction is a complex procedure which the approximation of the reservoir to the urethral stump can be a demanding step. The aim of the study is to evaluate the reproducibility of a modified posterior recons-truction (PR) during the reconfiguration of intracorporeal neobladder after robot assis-ted radical cystectomy (RARC). Materials and Methods: From July 2021 to July 2022, 35 RARC were performed, and 17 patients underwent intracorporeal neobladder reconstruction. A PR was planned males (14). Intra-and peri-operative data were collected. Surgical technique: RARC and node dissection are performed. Afterwards, 40-cm ileal segment is isolated; the portion with the more adequate mesenteric length is brought down to the pelvis. A modified PR is performed with a double-armed barbed suture: a first layer connects the Denonvillier's fascia to the rhabdosphincter in a running fashion; the second layer is created with the other arm and approximates the posterior side of the ileal segment towards the urethral stump. In the anterior caudal part the ileum, a 1.5-cm incision is made to realize the neobladder neck; the neovesical- -urethral anastomosis is performed with a second bidirectional suture. Results: Anastomotic and PR time were 14 (range 7-20) and 5 minutes (4-8), respecti-vely. A single Clavien IIIa complication was recorded in a patient who underwent NAC and had a C. albicans superinfection in the post-operative course. All patients were discharged with complete or acceptable bladder voiding. Twelve patients with follow- -up >90-days reported a satisfying daytime continence. Conclusions: PR represents a simple technical refinement that improves neobladder- -urethral anastomosis by favoring ileal approximation to the urethral stump and de-creasing anastomotic tension.

Automated summary

This study evaluates the reproducibility of a modified posterior reconstruction technique for robotic intracorporeal neobladder reconstruction. The technique improves the connection between the neobladder and urethral stump, reducing tension. The surgical outcomes were satisfactory, with patients achieving normal voiding.