Laparoscopic bladder diverticulectomy with two approaches
The video shows two surgical laparoscopic approach to treat bladder diverticulum. In the first case, a 47 years old female affected by a large posterolateral bladder diverticulum underwent an extravesical and transurethral approach; in the second case, a 52 years old male underwent a laparoscopic tranvesical approach.
In the first case we perform a transurethral and extraperitoneal laparoscopic combined approach. After creating the preperitoneal space by balloon trocar dissection, five trocars (2 x 5mm and 3 x 10mm port) are placed in hypogastrium. Identification of the diverticulum is made easier by bladder filling and cystoscope lighting. Bladder diverticulum is completely isolated. An absorbable suture is passed around diverticulum neck; so it is clamped with suture and Hem-O-lock clip. Resection of the diverticulum. Bladder is repaired with absorbable suture. In the second case, a extraperitoneal and tranvesical approach is performed. Transurethral placing of ureteral catheter; bladder is opened; isolation and resection of diverticulum. Suture of bladder wall with Vycril. Closure of bladder with absorbable suture.
Mean operative time was 180 minutes. No complications were observed in both cases.
Laparoscopic bladder diverticulectomy, both extravesical and transvesical technique, seems to be a safe and feasible procedure.