Step-by-step technique for single-port robot-assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci® SP™ surgical system

Objectives: To describe a step-by-step technique for robot-assisted radical cystectomy (RARC) with pelvic lymph node dissection (PLND) performed using the da Vinci (R) SP (TM) surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients and Methods: Four consecutive patients diagnosed with urothelial carcinoma of the bladder were counselled for RARC with PLND and ileal conduit urinary diversion performed using the da Vinci SP surgical system. A 3-cm midline incision was made 5-cm above the umbilicus. Dissection was performed to access the abdominal cavity. Insertion of the GelPOINT (R) advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) with the SP Cannula was performed through the incision made. A 12-mm AirSeal (R) (SurgiQuest Inc., Milfort, CT, USA) port for the assistant was placed on the pre-marked stoma site, where an ileal conduit urinary diversion was desired. Demographics and perioperative outcomes were collected under Institutional Review Board approval (IRB 13-780). The surgeries were performed by reproducing the steps of the institutional approach for RARC performed with the multi-arm robotic platform. Results: The surgeries were successfully completed. There was neither conversion to standard multi-arm robotic or open approaches nor the need for additional port placement. The mean (range) operative time was 454 (420-496) min. Blood loss averaged 312 mL. No transfusions were required and no intraoperative complications occurred. All patients had negative surgical margins. All patients were discharged on postoperative day 5. Conclusion: From our preliminary experience, RARC with PLND and ileal conduit urinary diversion is feasible and safe using the da Vinci SP surgical system. Further comparative studies with open and multi-arm robotic approaches are warranted.