Work

Robotic-assisted radical cystectomy with nerve-sparing and mesentery-sparing techniques and intracorporeal modified Y-shaped orthotopic neobladder

Year: 2025

Type: article

Abstract: Objective Bladder cancer in patients under 40 years represents 1% to 2.4% of all cases. In younger patients, radical cystectomy with pelvic lymph node dissection and urinary diversion raises significant concerns about urinary and sexual function preservation. This video/article describes our technique for preserving ileal vascularization (mesentery-sparing) combined with a retrograde nerve-sparing approach in robotic-assisted radical cystectomy (RARC). Patient and Surgical Technique We present a 39-year-old male who underwent RARC using a standard transperitoneal technique with two modifications: nerve-sparing (NS) and mesentery-sparing (MS). Intrafascial retrograde dissection ensured complete preservation of the neurovascular bundle (NVB). A 60-cm ileal segment was isolated for neobladder reconstruction using the MS technique. The neobladder was created by detubularizing the ileal segment and suturing it into a modified Y configuration. Pathology revealed high-grade invasive urothelial carcinoma with carcinoma in situ. Margins were negative, and all 28 lymph nodes were disease-free (pT2b pN0). Postoperatively, the patient achieved daytime and nighttime continence without post-void residual and had erections sufficient for intercourse one month after surgery. Conclusion RARC incorporating advanced NS and MS techniques provides effective oncological control with favorable functional outcomes. Preservation of vascular integrity in the ileum and neurovascular bundles is critical for achieving optimal continence and early recovery of erectile function. Our results highlight the importance of meticulous robotic dissection. Further studies are needed to validate these findings and broaden the application of these techniques.

Source: Urology Video Journal

DOI: 10.1016/j.urolvj.2025.100378

Authors: Eliney F. Faria, Rodrigo J. Costa-Gualberto, Carlos Vaz M. Maciel, Lucas Medeiros Burttet, Karolina B. Jorge, Marcos Tobias-Machado

Institutions: Faculdade de Ciências Médicas de Minas Gerais, Hospital Felício Rocho, Hospital de Clínicas de Porto Alegre

Language: English

Topic: Bladder and Urothelial Cancer Treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $800