Robotic bladder diverticulectomy is performed to repair diverticula—abnormal sacs or pouches in the urinary bladder that form when the bladder lining protrudes through the bladder wall. These pouches may be caused by a congenital weakness in the bladder wall—in which case there is typically a single diverticulum—but the condition typically develops later in life due to blockage of the lower urinary tract that leads to increased pressure inside the bladder. This blockage is usually the result of benign prostate hypertrophy, or BPH (enlarged prostate) though it can also be caused by scar tissue in the urethra, or nerve damage that causes bladder dysfunction. The acquired condition typically affects older men and involves multiple diverticula.
Bladder diverticula are associated with increased incidence of urinary tract infection, urinary tract stone development and bladder cancer. Robotic diverticulectomy is proving ideally suited to the repair of this condition. Not only does the minimally invasive approach lead to reduced post-operative discomfort and faster recovery time, but the excellent visualization provided by the da Vinci Si surgical system also facilitates the extensive urinary reconstruction required in the operation, resulting in minimal blood loss and often decreasing the time needed to perform the procedure.
In this procedure, the patient is anesthesized and four ports are placed in the abdomen using quarter-inch incisions. The robot's camera and three instrument arms are then inserted into the ports. The surgeon uses these instruments to free the bladder from its surrounding structures and isolate the diverticulum. The diverticulum is then excised with robotic scissors, and the bladder is sewn back up (reconstructed) using sutures just as in open surgery, but through tiny incisions, after which the closure is tested by filling up the bladder with saline. The excised diverticulum is then sent to the pathologist for evaluation, and a catheter is left in place for several days to ensure healing.
Less post-operative discomfort and scarring. Traditionally, a bladder diverticulectomy is performed using an open incision measuring 4 to 6 inches. Robotic surgery allows the same operation to be performed with four quarter-inch incisions, resulting in less pain and scarring.
Enhanced visualization and suturing ability. While laparoscopy relies on a two-dimensional image to guide the surgeon, robotics provides 3-D visualization of the operating site and also allows significantly easier and more precise suturing.
NYU Langone surgeons have pioneered and published on the technique for robotic diverticulectomy. The initial results with this procedure have been excellent, and we continue to utilize this approach as our first line of treatment for patients requiring bladder diverticulectomy.
To watch a video of this procedure being performed by one of NYU Langone Medical
Center's robotic surgeons, click on the link below.