Robotic assisted partial cystectomy for bladder endometriosis

This video of robotic partial cystectomy demonstrates the superior dissecting and suturing ability of the DaVinci surgical robot. The partial cystectomy is performed with ease, after the bladder and ureters are carefully prepared by cystoscopy and placement of ureteral catheters. This video is suitable for urological surgeons.

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Robotic assisted partial cystectomy for bladder endometriosis

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Abstract

This video of robotic partial cystectomy demonstrates the superior dissecting and suturing ability of the DaVinci surgical robot. The partial cystectomy is performed with ease, after the bladder and ureters are carefully prepared by cystoscopy and placement of ureteral catheters. This video is suitable for urological surgeons.

Classification

robotic

Keywords

endometriosis, bladder, cystectomy, robot

Media type

Surgical video

Duration

06'40''

Publication

2007-05

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E-publication

WeBSurg.com, May 2007;7(05).
URL: http://www.websurg.com/doi-vd01en2089.htm

Robotic assisted partial cystectomy for bladder endometriosis

1. Cystoscopy 00'17''

This patient was followed for primary infertility and pelvic endometriosis. She presented with a 3.5cm lesion of the vesical dome.The 1st step of the operation was a cystoscopy which confirmed the endometriotic lesion of the vesical dome. A lateral ureteral catheterization was performed and a cannula was introduced into the uterus.

2. Laparoscopic exploration 00'50''

The laparoscopic exploration begins with the uterus and the endometriotic lesions on the bladder, and on the right side, the ovary and Fallopian tubes. The exploration on the left side shows endometriotic lesions on the peritoneum.

3. Partial cystectomy 01'20''

Zooming in in front of the uterus allows visualization of the vesical dome and of the endometriotic lesions. We use the electrocautery hook in the right hand and the bipolar forceps in the left. Incision of the peritoneum begins in order to circumscribe the endometriotic nodule. The bladder has been opened and we go on with the incision of the right part of the bladder wall. Eversion of the nodule allows us to see the inner part of the bladder. We clearly see the endometriosis, the left and the right ureteral stents. Incision of the bladder mucosa at the posterior part of the endometriotic nodule is performed.

4. Bladder wall closure 02'26''

The excision goes on the vesical muscle, and the endometriotic tumor is removed. Careful examination of the margins is mandatory in order to detect any residual endometriotic nodule. You can appreciate how easy it is to make the eversion of the bladder mucosa thanks to the articulated instrument tips. The first stitch of 2/0 absorbable thread is put back hand. You can appreciate how easy it is to transfer the needle from one needle holder to the other. The 2nd stitch is forehand. Knot-tying is one of the surgical acts, which are the most simplified by robotics when compared to standard laparoscopy. This thanks to the articulated instrument tips and the 7 degrees of freedom, which are equivalent to those of the human wrist. Stitches can be very precisely applied. We have a small part of mucosa and a more important part of bladder muscle. All the stitches can be applied as one wants and not as one can, which is sometimes the case in standard laparoscopy. The 2nd running suture begins on the left part of the bladder incision. You can again appreciate the movements of the articulated instrument tips and the precision of the stitches. You can also notice the extremer stability of the robotic instruments when compared to the unwanted movements of the assistant’s scissors. The last knot is tied in the bladder. This can be done quite as quickly as in open surgery. For here 3-dimension revision is also of great help for that. Water-tightness is checked and the bladder is then filled with methylene blue saline. After checking for hemostasis, the peritoneum is closed with absorbable 2/0 sutures. No suction drain was needed. The zooming in is performed directly by the surgeon at the console. So does the zooming out and the translation of the optic to the left side of the patient.

5. Coagulation of peritoneal endometriosis 05'51''

Coagulation of the peritoneal endometriotic lesions is performed with a bipolar forceps. At the end of the operation we check for permeability of the Fallopian tube. The specimen is put in an endobag introduced by the assistant’s port and then extracted. Three ports were used for the robot instruments and one for the assistant. The follow-up was uneventful. Control cystography showed a normal bladder. The patient went pregnant one year later.