Ves.Pa. - Designing a Novel Robotic Intracorporeal Orthotopic Ileal Neobladder

OBJECTIVE: To present a detailed description of the "Ves.Pa." procedure to create a novel robotic intracorporeal ileal orthotopic neobladder, together with technical tips for the creation of a time-efficient robotic intracorporeal neobladder. MATERIALS AND METHODS: We evaluated the presumed volume of the final Ves.Pa. in silico, exploring ex vivo the anatomical and technical feasibility of reconfiguring the bowel. During tests performed in a robotic pelvic model, procedures were recorded to identify possible improvements in operating times. RESULTS: After initial evaluation of the anatomical feasibility of the technique, its practicability was confirmed during ex vivo tests. It is also possible to create two different versions of the pouch, in cases of short right or short left ureter ("Ves.Pa. Reverse"). Tests on our robotic pelvic model confirmed the feasibility of the technique, and some details to improve its time efficiency were identified, for example, further simplification of the suturing of the neobladder. CONCLUSION: Despite the increasing use of robotic radical cystectomy, most urological departments do not perform "ideal" intracorporeal urinary diversion due to perceived technical difficulties in reconfiguring the ileum and operating times in comparison with open surgery. An idea for a novel intracorporeal robotic orthotopic neobladder (with many characteristics for creating a feasible test pouch) has been designed. Clinical studies are needed to confirm these findings.