Robotic cystectomy with intracorporeal neobladder is an option for some patients with bladder cancer and is associated with smaller incisions, less pain, and faster recovery. In this video you will learn firsthand from Dr. Mark Gonzalgo, Professor and Vice Chair of the Department of Urology at the University of Miami as he performs this complex surgery focusing on the reconstructive aspects of the procedure including bowel segment isolation and neobladder construction.
So this patient was diagnosed with muscle invasive bladder cancer and uh underwent neoadjuvant chemotherapy, which is a strategy we used to try to optimize his cancer control. Uh So in combination with surgery chemotherapy will achieve hopefully the best outcome for this patient. We're using a robotic approach for this procedure which hopefully again, will allow the patient a quicker recovery, less pain, less discomfort right there is fine, you know. Yeah. Good. Close. Yep. So we're gonna have a lot of length on this, I guess. Yeah, that's good. They're close. Perfect. Thank you. That's good. Do you know yet? Uh Thank you. Oh, yeah. Yeah, I mean for permanent, it's almost like a, a groove director and the T I maybe more if I want it to get a little bit better, back up a little bit there. All right. This is what portion of the neobladder, distal portion of the neobladder, right. So, thank you. He's ready for the uh I know he's a little, he's an hour or 22, right? That's a discard, right. Go ahead. Yeah. Gonna take this out. Do push in. Yeah, close that I think it is. Show me there. I think we're good to rotate back. OK. Close that I feel we go close to here. Why not? There we go. Mhm. Yeah. Plenty, plenty long for a front limb. It doesn't need to be that. OK. Well, that posterior plate, right? So I'll do it in two just so it doesn't avoid it. We, yeah, you hair. It's naturally laying here for this. Cuz the next step is to open this and then let's see how that's put together like that, do you know? Right. It's pretty good there. So that's what I'm saying. Where's the halfway point of this? Because this is gonna be the the uh urethra right there. So maybe around here we'll call it halfway more or less, right? But I need that dyed suture, take this out, lay down. Ok? Good enough there. Thank you. Alright. That's yeah. All right. So we'll need scissors in the right hand. Yep. Section in there. Section section. That's good there, section that there. No I'm in now I'm in a little bit there. There you go. Stop that there. Snap that or something going up. Ok. Do you know? Ok. When you pull the wire now I I think it's going up so that's good there. At least you don't, you don't know why not. I might as well. Ok. Yeah. All right. As long as there's urine coming out, we're good. Yeah. Push it in a little bit more. There we go and out. I pulled the wire out completely. Let me think, pulling back and being careful is it was a purse string. But I didn't think the purse string was that tight. Even with the, uh, with the, um, V, I mean, I should be able to do this tight and it's fine. It's a chromic. Right. So, that's how tight they were. Well, you know, because you called me, which was the correct thing to do, was it or something? Because they couldn't pull it out? Right. That, that's good enough there, I think. Yeah, you're gonna get it up. Um Yeah, thank you. Cut it wide to allow for that to come down like that like this, you know. Right. You got an asthmatic suture. All that jazz there. All right. So I think that's it. The 20 bike roll if you got it undyed, but I'll take the two needle drivers, you need to register this computer to this. That's, that's when you get a chance to, to change the battery, your mic died. So whenever you get a chance to switch out the battery, I send her back, back, back back. Um ok. Yeah, we gotta get that with the bipolar just rubbing on it so much. That's why, right. Bring everything else. Well, you need to do a anterior reconstruction equivalent basically like this over the catheter, right? And then you can suture it and it'll be done. Otherwise you're not gonna be able to close it right properly. So, so this will this may help continent as well though. So I'm not too worried here, but essentially that's what this is. Do one more here, then they get it, do bipolar up top and man right there. Got it there. Hi. Do you know? Ok, let me hear. All right. I think that looks good there. Get your sucker in there, hold that down and we go here, looks in there, pull it back. Ok. Push it in. So I take a look at that. Ok. So the balloon is way back there, right? So that's fine. Pull it back a little bit now. Rotate it. So we know it works. All right. That's good there. All right. So that's try to leave it in that orientation for now. Ok. Stop for a second. All right. Leave it there. Don't no need to manipulate it anymore. I know it's in, yep. Nine inch V lock V 20 section is here. Remove the suture here.
