Robot-Assisted Laparoscopic Bladder Diverticulectomy: Adaptation of Techniques for a Variety of Clinical Presentations.

Objective: To report our experience in robot-assisted laparoscopic bladder diverticulectomy (RALBD) with a focus on technical modifications aimed at accommodating for differences in anatomy and pathologies. Materials and

Methods: A prospective database was maintained for 20 patients who had RALBD at our institution. Clinicopathological and follow-up details including concomitant procedure performed were reviewed for each case. Two patients had intra-diverticular urothelial carcinoma refractory to endoscopic and intravesical management. The dissection of the diverticular neck was performed utilising one of the 3 approaches: extravesical (8 of 20 patients), transvesical (11), and trans-diverticular (1). Pre and postoperative postvoid residual and International Prostate Symptom Score were compared using paired-sample t test. In addition, 6 patients underwent open bladder diverticulectomy during the period and their perioperative parameters were compared with the RALBD group.

Results: The median age was 66 and the average BMI was 27.2. Thirteen patients underwent major concomitant urologic procedures. Mean operative duration was 184 minutes with average length of hospital stay at 2.1 days. One Clavien 3 complication was encountered. There were significant improvements in pre & postoperative postvoid residual (425-49 ml, P = .000) and International Prostate Symptom Score (19-6, P = .033). When compared to open bladder diverticulectomy, RALBD is associated with reductions in blood loss (100 ml vs 283 ml, P = 0.003).

Conclusion: Despite the wide variability in clinical presentations, RALBD is associated with minimal surgical morbidity and good perioperative outcomes. It can be safely performed in conjunction with other major urologic procedures in the pelvis.