Robotic Orthotopic Intracorporeal Neobladder using the Ileal bowel segment is a technically challenging surgical procedure. So, in this video, we describe a few tips to help standardize the neobladder reconstruction and make it reproducible.

The steps for standardizing the construction are demonstrated in the video.

Video Clip:
Step 1: Apical Fixation
The antimesenteric border of the ileum that has been selected for the construction of the neobladder is approximated and sutured posterior to the urethra. This facilitates tension-free vesicourethral anastomosis along with apical fixation, helping to stabilize the bowel and limit movement.

Step 2: Early Vesicourethral Anastomosis
An opening is made at the intended anastomosis site on the ileal segment, and vesicourethral anastomosis is carried out. The apical fixation from the prior step helps with placing the urinary catheter at the site of anastomosis.

Step 3: Stay Sutures to Facilitate Neobladder Reconstruction
Our neobladder will have a 40 cm ileal segment for the pouch and 10-15 cm for the chimney making each wall about 20 cm long. In this step, we place 4 stay sutures at 5 cm intervals. Once we place the stay sutures the distal suture will be held with the 3rd arm of the robot and the proximal suture is held with the help of the physician’s assistant. The traction allows for suturing along a straight line allowing for the reconstruction of the neobladder in an easy, smooth, and standardized fashion.

In conclusion, the robotic neobladder reconstruction is a complex procedure but, following the steps mentioned in this video has allowed us to simplify the neobladder reconstruction making it more standardized, repeatable, and easy.