Presentation Authors: Juan Garisto*, Riccardo Bertolo, Mohamed Eltemamy, Jihad Kaouk, Cleveland, OH
Introduction: The FDA approved da Vinci SP (Intuitive Surgical, Sunnyvale, CA) surgical system was developed specifically to facilitate single-site surgery, with the ideal aim to further reduce the invasiveness. We aimed to report our initial clinical experience with bladder diverticulectomy and concurrent ureteral re-implantation using the SP surgical system. Specifically, the technical points of the procedure were highlighted.
Methods: A 54 y/o male with recurrent urinary tract infections came to our observation. Abdominal ultrasonography showed post-voided residual volume over 500 ml and left hydronephrosis. Urinary cytology was negative. Cystoscopy was performed diagnosing a bladder diverticulum, adjacent to the left ureteral orifice. Moreover, a 1.5 cm bladder stone was found. Cystogram confirmed the presence of a large diverticulum. The patient was scheduled for diverticulectomy and eventual ureteral reimplantation. After counseling, the patient accepted to undergo surgery performed using the SP surgical system.
Results: The robotic diverticulectomy was performed. Due to the large diverticulum and its proximity to the left distal ureter, we opted for concurrent ureteral reimplantation. The procedure was successfully performed. No intra-operative complications occurred. The operative time was 150 min. Blood losses were 50 ml. The patient was discharged on the 1st postoperative day. Bladder catheter was removed after negative cystogram on the 10th postoperative day.
Conclusions: The feasibility, the safety and the effectiveness of one-stage single-port robot-assisted bladder diverticulectomy and ureteral reimplantation using the SP Surgical System is reported herein.