Introduction: To present the surgical technique for robot-assisted wire-guided extravesical bladder diverticulectomy and simultaneous Y-V plasty for recurrent bladder neck stricture. Methods: A 58-year-old man referred to our center for recurrent LUTS after TURP. Thereafter, the patient underwent TUIP and 2 endoscopic bladder neck incisions, unsuccesfully. A CT scan showed two bladder diverticula of 4 and 8 cm located on the right and left postero-lateral wall, respectively. The patient was scheduled for robot-assisted bladder diverticulectomy and Y-V plasty for recurrent bladder neck stricture. As first step, a double J stent was placed bilaterally and a guidewire was inserted in the lumen of each diverticulum to facilitate their identification and handling. The robotic stage was performed with Da Vinci Xi platform, with the patient in supine position, with a 25 degrees Trendelemburg. Six ports were placed across the lower abdomen, transperitoneally: four 8 mm robotic trocars and 2 assistant trocars (12 and 5 mm). The peritoneum was incised to expose posterolateral bladder wall. Perivesical fat was dissected and protruding mucosa of the diverticula isolated. A blunt dissection was mostly used, detaching the mucosa from the bladder wall. Once completely isolated, bladder mucosa was entirely excised and the neck of the diverticulum closed with a triple-layer continuous 3-0 monofilament absorbable suture. Retzius space was then opened and prostatic defatting was performed. The bladder neck was incised obtaining a Y-shaped flap. Two stay 3-0 monofilament sutures were placed at the end of the two branches of the Y. The flap was advanced and the margins closed with a double-layer emicontinuous 3-0 barbed absorbable suture. Results: Operative time was 318 min. Estimated blood loss was 200 mL. There were no perioperative or postoperative complications. A voiding cystourethrogram before catheter removal, after 12 days, showing almost complete resolution of diverticular protrusion. Ureteral stents were removed 30 days post-operatively. Conclusions: Robot-assisted extravesical diverticulectomy and simultaneous Y-V plasty of the bladder neck is a safe and feasible procedure. Endoscopic guide-wire insertion into the diverticulum allowed for easier traction and dissection of the tissues. Advantages of the procedure consist of avoidance of cystotomy, easy individuation and excision of diverticular mucosa and concomitant resolution of relapsing cervico-urethral obstruction. SOURCE OF Funding: None
