Introduction: For well over 50 years, intestinal segments have been successfully used for urinary tract reconstruction, including procedures ranging from ileal conduit to ileal ureter interposition.
With the advent of robotic techniques, it is now feasible to transfer open surgical techniques to minimally invasive platforms to perform these same procedures with excellent outcomes.
Methods: Utilizing standard open techniques for working with bowel segments translated onto the robotics platform, we can isolate the appropriate vascular pedicles for the intestinal segments, harvest bowel segments as needed and perform complex reconstruction as outlined in our video. Care is taken to make sure that the vascular supply and the re-alignment of the bowel segments are appropriate and consistent with core basic surgical principles and techniques.
The principles of management for these procedures are the same. The advantage of the robotic approach is that we do not manipulate or retract on the bowels like we do with open surgical procedures and thereby enhancing early recovery and minimizing ileus.
Results: All three of the procedures mentioned in this video were successfully performed entirely robotically. The morbidity and the complication rates are extremely low and compares favorably with any published literature.
Conclusions: With experience and with the knowledge of the basic bowel and vascular techniques, intestinal segments can safely be utilized for advanced urologic reconstruction using the Da Vinci robot.