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Robotic Bladder Diverticulectomy

Dr. Stephen Lukasewycz

What is this procedure?Tap to read

A bladder diverticulum is a pouch that bulges out through a weak spot in the bladder wall. Urine can sit in it, causing infections, stones or trouble emptying.

Diverticulectomy: the surgeon removes the pouch and stitches the bladder wall closed.

Robotic: the surgeon works through several small ports in the abdomen using the robot. The abdomen is inflated with gas to make working room.

Afterward: a catheter stays in while the bladder heals.

Key points

Possible cystoscopy and/or ureteral stent placement before docking (not every case). If so: C-arm with foot pedal, Sensor wire and a 6 Fr ureteral stent; call the X-ray tech before the patient is in the room.
General anesthesia with paralysis.
Low lithotomy in Yellofins, bare back on the gel pad, arms tucked in sleds, Mayo stand over the head before draping.
AirSeal for insufflation in all robotic surgery suites.
Specimen: diverticulum to pathology in formalin.

Ports

8 mm da Vinci ports ×4
12 mm AirSeal port ×1
5 mm threaded trocar ×1
First (camera) port: blunt black reusable obturator from the robot set. Remaining ports: bladeless obturators.
1% lidocaine plain for port sites.

Robotic instruments

Open

Monopolar scissors
Fenestrated bipolar
ProGrasp
Large needle drivers ×2
0° robotic scope

Available in room, open only if asked

30° robotic scope

Assistant (PA) instruments

Open

Long suction irrigator
Hunter laparoscopic bowel grasper
Weck Hem-o-lok applier, regular, with regular clips
Laparoscopic scissors

Available in room, open only if asked

Weck Hem-o-lok large applier and large clips
10 mm laparoscopic spoon (Snowden Pencer)

Sutures

Bladder closure: 2-0 V-Loc and 3-0 V-Loc.
12 mm assistant port: PMI and 0 Vicryl.
Camera port: 0 Vicryl UR-6.
Skin: 4-0 Vicryl.

Other supplies

Open

20 Fr Foley ×2
19 Blake drain with bulb, and 2-0 silk to secure it
10 mm Inzii retrieval bag

Available in room, open only if asked

Surgicel 4×8 sheets and Surgicel powder
If cystoscopy/stent: cysto set (rigid scope), 30° lens, camera, GloShield
If stent: C-arm with foot pedal and C-arm drape, Sensor wire, 6 Fr ureteral stent

Gloves: MD and PA

MD

Port placement: single 7.5 white.
Closing: double glove, 7.5 blue under 7.5 white.

PA

Aimee: 7 blue, 6.5 white
Carras: 7 blue, 6.5 white
Heather: 6.5 micro ×2
John: 7.5 blue, 7 white
Olivia: 7 blue, 6.5 white

Anesthesia

General anesthesia with paralysis.
Perioperative antibiotics: cefazolin (Ancef) 2 g IV, unless otherwise noted or allergy.

Positioning

Low lithotomy in Yellofin stirrups.
Bare back directly on the gel pad.
Arms padded and tucked at the sides in arm sleds.
Mayo stand placed over the head before draping.

Prep and drape

Shave the abdomen from the xiphoid to just above the pubic bone.
ChloraPrep from nipples to pubis, including penis, scrotum and inner thighs.
Drape with five blue towels secured with Ioban strips.

Specimens

Bladder diverticulum, to pathology in formalin.
Wound class: II (clean-contaminated).

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