Robotic-Assisted Laparoscopic Intracorporeal Urinary Diversion Raj S. Pruthi, Jeff Nix, Dan McRackan, Adam Hickerson, Matthew E. Nielsen, Matthew Raynor, Eric M. Wallen  European Urology  Volume 57, Issue 6, Pages 1013-1021 (June 2010) DOI: 10.1016/j.eururo.2009.12.028 Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 1 Port placement including (a) robotic ports (red) and (b) assistant ports (green). European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 2 A 20-cm silk suture (black) is used to measure bowel segment, and 3-0 Vicryl stitch is used to tag the bowel. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 3 In the case of neobladder, the midpoint of the bowel segment is brought into deep pelvis to ensure adequate tension-free descent to the urethra. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 4 (a) An endovascular stapler and cutter is placed across the bowel and mesentery. (b) The stapler is fired, and the bowel and mesentery are divided. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 5 (a) Lumen of each end of the bowel segment is brought over each jaw of the stapler. (b) The stapler is closed and fired to create the anastomosis. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 6 The remaining bowel opening is closed using endoscopic stapler/cutter. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 7 The stapler is then used to staple down the antimesenteric portion of each bowel section, thereby detubularizing the bowel and creating the reservoir in case of neobladder. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 8 (a) Posterior wall of neobladder to urethra anastomosis is performed. (b) After introduction of the Foley catheter, the anastomosis is completed anteriorly in a running fashion. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 9 (a) Diagram and (b) intraoperative image of the first suture of the ureteroenteric anastomosis. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 10 The ureteroenteric anastomosis is completed. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 11 The tip of the stent (with guidewire in place) is then grabbed by the robotic surgeon and passed up the ureter. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 12 (a) Diagram and (b) intraoperative image demonstrating how the distal tip of the stent is drawn back out of the ostomy end of the conduit. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 13 Postoperative image of female patient who underwent robotic radical anterior pelvic exenteration, bilateral pelvic lymphadenectomy, and intracorporeal orthotopic ileal neobladder. The specimen was placed in an impermeable sac and withdrawn through a small incision in the posterior vaginal wall. European Urology 2010 57, 1013-1021DOI: (10.1016/j.eururo.2009.12.028) Copyright © 2010 European Association of Urology Terms and Conditions