Transvesical versus Transabdominal - Which is the Best Approach to Bladder Diverticulectomy using the Single Port Robotic System?

Introduction and Objective Application of the Single Port (SP) robotic platform [Intuitive®] is expanding.  Using two illustrative examples of bladder diverticula (BD) resulting from bladder outflow obstruction (BOO), we describe in this video our techniques utilising SP to treat BD via Extravesical (EV#1) and Transvesical (TV#2) approaches. Methods In EV#1, a 56 year old, with BOO due to benign prostate enlargement (BPE) of a 30ml prostate, and a 5cm BD, was treated with RABD-SP. A sub-umbilical SP access was used to approach and excise the BD in an EV fashion. The BPE was treated with Rezum®. A 16Fr urethral catheter was placed. In TV#2, a 67 year old, with urinary retention due to a 55ml BPE and a 6cm BD in the right posterolateral aspect adjacent the ureteric orifice (UO), was treated with RABD-SP using a Gelport® (no additional assistant ports). An open cut-down was performed onto a pre-filled bladder and secured onto the abdominal wall with stay sutures. After draining the bladder, a Gelport was introduced into the bladder for SP docking with pneumo-vesical insufflation. Intravesical (inside-out) excision of the BD was performed with protection of the adjacent right UO with an open access ureteral catheter. Utilising the TV access, a simple prostatectomy was performed. A 22Fr, 3-way catheter was placed at the end. Results For EV#1 and TV#2, estimated blood loss (EBL) were 5ml and 100ml, length stay was 1 day in both, without any immediate peri-operative complications. Both patients had successful trials of void on post-operative day 7 and 9 respectively. Conclusions RABD-SP can be customised to treat bladder diverticula, via transabdominal (extravesical) or transvesical (with bladder pneumo-insufflation) approaches, and combined with different BOO treatments (Rezum® or simple prostatectomy, for instance), in a patient-specific personalised manner.