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BACKGROUND: Although most hyper-reflexic, high pressure bladders can be managed with some combination of medications, bladder injections, or neuromodulating implants, bladder augmentation is necessary for some patients to improve compliance and lower storage pressures. We demonstrate our technique for intracorporeal robotic bladder augmentation.
METHODS: Six ports are placed in a fashion similar to a robotic cystectomy and intracorporeal ileal loop. The camera is 22 cm above above the umbilicus, and two robot ports are placed 6 cm apart on the right side. On the left moving medial to lateral from the camera port, there is a 12 mm assistant port, 8 mm robot port, and a 12 mm assistant port just off the anterior/superior iliac spine. The ileum is thoroughly mobilized. A 20cm segment of ileum is selected and divided with a 65 cm battery operated EndoGIA stapling device. Bowel continuity is restored in a side to side fashion. The augment segment of ileum is opened on its antimesenteric side and oriented in the shape of Ω. The two dependent arms of Ω are sutured together to create the ileal patch. The dome of the bladder is opened longitudinally, and the bowel patch is anastomosed to the bladder with running 2-0 Vicryl sutures.
RESULTS: Total robotic time was 398 minutes and total operating room time was 435 minutes. The patient was discharged on postoperative day #5. Videourodynamics demonstrated marked improvement in compliance and capacity two months later.
CONCLUSIONS: Intracorporeal robotic ileal cystoplasty is a feasible option for patients requiring bladder augmentation.