Indiana Pouch Robotica Intra-corporea

Giuseppe Simone1, Giuseppe Romeo2, Francesco Minisola1, Salvatore Guaglianone1, Leonardo Misuraca1, Mariaconsiglia Ferriero1, Andre Luis de Castro Abreu3, Rocco Papalia4, Riccardo Mastroianni4, Vincenzo Pompeo1, Monish Aron3, Mihir Desai3, Indebir Gill3, Gabriele Tuderti1, Michele Gallucci1
  • 1 Istituto Nazionale Tumori "Regina Elena" (Roma)
  • 2 Università "Federico II" di Napoli (Napoli)
  • 3 USC Institute of Urology and Departments of Urology Keck School of Medicine, University of Southern, Department of Urology (Los Angeles )
  • 4 Campus Biomedico (Roma)

Abstract

Surgical steps: Robotic cystectomy and pelvic lymph node dissection (PLND) are performed with a 6-trocar access. Robot is undocked and specimen extracted from the left lateral port. Both left side ports are closed and three additional ports are placed. Table is rotated 45 degree to left and the robot is re-docked on right side. 12 cm of distal ileum and 30cm of right colon are isolated; side to side stapled ileocolonic anastomosis is performed; colonic segment is detubularized along the antimesenteric tenia up to 3cm distal to the ileocecal valve and U folded. The medial aspect of the folded colon is sewn. Ureterocolonic anastomoses are performed on the posterior aspect of the pouch. Bilateral J stents are placed in ureters and secured to a 24-Fr hematuria catheter inserted via the appendiceal orifice. After closing the lateral aspect of the pouch, a Foley catheter is inserted via the umbilical port and through efferent ileal limb and placed into the colonic pouch. The efferent limb is tapered with a 60mm stapler on the antimesenteric aspect. The ileocecal valve and the efferent limb are plicated to increase the outflow resistance. The efferent limb is now extracted and the stoma created at the umbilical site.

Argomenti: