Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles

Background: The Vescica Ileale Padovana (VIP) was first described in 1989 as a technique for total bladder replacement, and gained popularity due to technical simplicity and functional advantages.

Objective: To report preliminary results and a detailed step-by-step surgical technique description of robot-assisted VIP (ra-VIP) that replicates the open technique principles.

Design, setting, and participants: We report the data of 15 consecutive patients who underwent robot-assisted radical cystectomy (RARC) and totally intracorporeal ra-VIP at our institution from April 2015 to March 2017.

Surgical procedure: RARC, extended pelvic lymph-node dissection, and totally intracorporeal ra-VIP. An enhanced recovery after surgery (ERAS) protocol was adopted in most cases.

Measurements: Perioperative outcomes (operating time, blood loss, transfusion rate, and hospital stay), readmission for early (30d) and late (90d) postoperative complications, pathological and oncological outcomes, and overall/cancer-specific survival were reported.

Results and limitations: The median (interquartile range) age was 60 (54-66)yr. The median body mass index was 24 (24-25). The median American Society of Anesthesiologists score was 2 (2-2). The operative time was 390 (284-470)min and the estimated blood loss was 300 (50-900) ml. No conversion to open technique was reported. The median hospital stay was 17 (12-23)d. Three patients received postoperative transfusions. Six patients had 90-d major complications. One patient was readmitted after discharge and reported a long-term sequela. One positive margin was reported. At a mean follow-up of 17 (13-25)mo, 14 (93%) patients were alive: one patient died from disease progression. Daytime continence rate at 12mo was 62%.

Conclusions: Our preliminary results showed that ra-VIP appears to be a feasible technique for robot-assisted totally intracorporeal bladder replacement following robotic radical cystectomy.

Patient summary: Vescica Ileale Padovana (VIP) was first described almost 30yr ago for bladder replacement after radical cystectomy. We report a step-by-step technique of robot-assisted VIP that follows the open surgical principles of detubularization and double folding, mixing the advantages of VIP with the benefits of the robotic approach.