Our video shows the reconstruction of a neobladder in a patient with bladder cancer. The bladder has been removed; the video explains the basic steps for a …
for this procedure we use a DaVinci si
system with four arms and the standard
six port access this is the sight of the
right extended lymphadenectomy following Cystectomy
here the left ureter is drawn under the
mesorectum and positioned with the right ureter
50 centimeters of ileum are needed for
the pouch the first 10 centimeters are
the chimney and the remaining 40
centimeters form the neobladder
the distal 30 centimeters of ileum are
retained for reabsorption requirements
the ileocecal Junction is identified and
the small bowel graspers are used to
measure off the ileum the jaws are 5
centimeters long
in the first step of the Ileourethral anastomosis the rectoprostatic fasciae is used to
help create a tension-free approximation
of the ileum to the urethral stump
the actual anastomosis is then created using a 3-0 double-armed barbe suture
after the anastomosis the ileum for the
pouch is excised using endo GIA sixty staplers
to re-establish the continuity
of the small bowel the ends are opened
and a side-to-side anastomosis is
performed with the endo GIA 60
we use an additional 45 millimeter
stapler to ensure an adequate lumen
the 60 millimeter stapler is again used
to close off the bowel
2 holding sutures are placed ten
centimeters proximal to the ileo
urethral anastomosis suture A will mark the deepest point of the closure of the
ventral wall of the pouch and suture B
is the point to which the pouch will
later be folded
the antimesenterial wall is then
opened over 40 centimeters
the two limbs are approximated and fixed
up point CD
the dorsal wall of the pouch is closed using 3/0 barbed running sutures
again using barbed sutures the pouch is
folded and fixed
the distal ventral wall of the pouch is
closed
the ureters are held together in the
forth arm and incised longitudinally
the inner edges are sewn together in a
running suture to form the wallace plate
after the stapler rows of the chimney are
excised the Ch8 mono J catheters
are inserted through the abdomen using
Venflon catheters
the catheters are threaded through the
chimney and into the ureters
the ilioureteral anastomosis is
performed using a double armed running suture
finally the last segment of the ventral
wall is closed around the catheters
the pouch is filled over the indwelling
catheter to ensure water tightness

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