Trans-perineal approach for Intracorporeal Ileal Conduit Urinary Diversion using a Purpose-Built Single-Port Robotic System: step-by-step.

OBJECTIVES: To describe the step-by-step technique for single-port trans-perineal intracorporeal ileal conduit urinary diversion using a purpose-built robotic platform.

METHODS: In one male cadaver the da Vinci SP1098 Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform intracorporeal ileal conduit urinary diversion by trans-perineal approach after radical cysto-prostatectomy and bilateral pelvic lymph node dissection. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12 × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm accessory laparoscopic instrument were placed. Moreover, at the planned level of the cutaneostomy, a 12-mm port to accommodate the Endo-GIA was placed. The primary outcomes were the technical feasibility, the operative time and the record of eventual procedural complications.

RESULTS: The intervention was successfully completed without neither conversion nor need for additional ports. The total operative time was 200 min. Operative time for urinary diversion was 90 minutes.

CONCLUSIONS: We demonstrated the feasibility of single-port trans-perineal intracorporeal ileal conduit urinary diversion using the SP1098 purpose-built robotic platform. Limitations include the preclinical setting. The applicability in the clinical model is awaited to be tested after the platform will be commercially available.