Robotic assisted laparoscopic bladder diverticulectomy

Purpose: Surgical management for bladder diverticuli includes open, endoscopic and standard laparoscopic techniques. To our knowledge we report the first series of robotic assisted laparoscopic bladder diverticulectomies. Materials and Methods: Five patients underwent robotic assisted laparoscopic bladder diverticulectomy between December 2004 and December 2006, as performed by a single surgeon using the da Vinci(R) robotic system for symptomatic diverticuli. The records were reviewed, the surgical technique is described and a review of the literature was performed. Results: All patients underwent cystoscopy, ureteral stent placement and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized and transected at its neck, and the bladder was closed in 2 layers. One patient underwent ureteral reimplantation for a Hutch diverticulum. Median total operative time was 178 minutes (range 163 to 235) and robotic operative time was 83 minutes (range 63 to 143). Length of stay was 3 days (range 1 to 6). Two patients who underwent transurethral prostate resection before diverticulum resection did well. Two patients in whom medical management failed ultimately underwent transurethral prostate resection and 1 patient continued on medical therapy with regular followup. Conclusions: Robotic assisted laparoscopic bladder diverticulectomy is safe and effective for patients with a large bladder diverticulum and small prostate. Perioperative surgical outcomes rival those of previously reported open, endoscopic and laparoscopic diverticulectomies.