Name:
Robotic Intracorporeal Ileal Conduit Urinary Diversion Technique
Description:
Robotic Intracorporeal Ileal Conduit Urinary Diversion Technique
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/0298a47b-ec57-4347-abea-0d0d126e2674/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=SfFI2KB85VoniYzDW6H%2F0D81%2BfI2UaJNV1r5eJ9de7c%3D&st=2026-05-23T19%3A25%3A56Z&se=2026-05-23T23%3A30%3A56Z&sp=r
Duration:
T00H11M48S
Embed URL:
https://stream.cadmore.media/player/0298a47b-ec57-4347-abea-0d0d126e2674
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/0298a47b-ec57-4347-abea-0d0d126e2674/Intracorporeal ileal conduit.mp4?sv=2019-02-02&sr=c&sig=zlA8lQr9YBcPa3oUFf4qujhEI9xhisdDcAt3vF8rPpw%3D&st=2026-05-23T19%3A25%3A57Z&se=2026-05-23T21%3A30%3A57Z&sp=r
Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 STEP 1.
SPEAKER: A six port configuration is utilized with four robotic ports and two assistant ports.
Segment:2 STEP 2.
SPEAKER: The terminal ileum is divided approximately 15 centimeters from the ileocecal valve. This area will become the distal and the ileal conduit. Staplers brought in through the lateral 15-millimeter assistant port and the jaws of the instrument approach the bowel in a perpendicular fashion. A blue bowel cartridge is employed.
SPEAKER: After stapling, a dyed suture is used to tag what will become the distal end of the ileal-ileal anastomosis for ease of identification later in the procedure. The mesenteric defect is deepened using a white vascular load of the stapler.
SPEAKER: A 15-centimeter segment of ileal conduit is measured, and the bowel is, again, transected in a perpendicular fashion, using a blue bowel load brought in through the 15-millimeter assistant port. Note that the entire length of the jaw is not utilized in this area to avoid the need for a deep mesenteric defect.
Segment:3 STEP 3.
SPEAKER: A 5-centimeter bowel discard segment with the stapler brought in through the superior 12-millimeter assistant port will be used to avoid the need for a deep mesenteric defect, but still allow for conduit mobility in this proximal portion.
SPEAKER: Immediately upon transecting the bowel discard segment, an additional dyed suture is used to tag the proximal portion of what will become the ileal-ileal anastomosis. The bowel discard segment is then cut away using a combination of vessel sealer and monopolar cautery, staying close to the edge of the bowel so as not to deepen the mesentery on this side.
SPEAKER:
Segment:4 STEP 4.
SPEAKER: The conduit is laid caudally and the ileal-ileal anastomosis is planned to be anterior to the conduit segment.
SPEAKER: The corners along the anti mesenteric surface of the proximal and distal portions of the terminal ileum are cut away using cold monopolar scissors. The stapler is brought in through the lateral 15-millimeter assistant port with a blue bowel cartridge. The stapler is held steady by the assistant as the surgeon guides one limb of the ileum onto each jaw at a time.
SPEAKER: The tagged dyed sutures are utilized to assist in bringing the ileum to the end of the stapler. The stapler is then lifted by the assistant prior to closing the jaws to ensure approximation of the anti-mesenteric borders of both limbs of the ileum.
SPEAKER: A second stapler load is used to lengthen the ileal-ileal anastomosis. This is first brought into the lumen with closed jaws followed by opening to ensure that one stapler jaw goes into each limb of the ileum.
SPEAKER: Again, prior to closing and firing, care is taken to ensure that the anti-mesenteric borders are lined up. An additional stapler load is brought in through the 12-millimeter superior assistant port in order to seal the ileal-ileal anastomosis.
SPEAKER: Sometimes this does require two staple loads in order to have appropriate closure.
Segment:5 STEP 5.
SPEAKER: Indocyanine green is injected intravenously, and the fluorescence capability of the robotic system is used to assess the vascular integrity of several areas, including the ileal conduit segment, the distal ureters, as well as the ileal-ileal anastomosis as demonstrated here.
SPEAKER:
Segment:6 STEP 6.
SPEAKER: In planning the ureter ileal anastomosis, DeBakey forceps and scissors are used in combination to cut away a small segment of the bowel wall entering through the mucosa into the lumen of the conduit.
SPEAKER: The ureter is then cleaned and spatulated. The length of ureteral spatulation is approximately one to 1 and 1/2 centimeters, and care must be taken to ensure proper anatomic orientation to ensure the spatulation occurs on the proper side.
SPEAKER: Using a 4-0 braided suture on a cutting needle, the apex suture is placed.
SPEAKER: Additional interrupted sutures are used to reapproximate mucosa to mucosa along the posterior plate of the ureteral ileal anastomosis. Once the posterior portion is completed, a 6 French stent over a guidewire is inserted through a suprapubically placed mini port.
SPEAKER: The stent is then carefully advanced proximally through the ureter into the kidney. Once the wire is removed, the distal curl is placed into the ileal conduit lumen. At this point, the excess distal ureter is cut away to allow for ease of completion of the ureteral ileal anastomosis.
SPEAKER: The remaining portion of the anastomosis is completed using a combination of interrupted and running technique. Again, a braided suture on a cutting needle is utilized. Care is taken to ensure adequate serosal bites on the bowel side while still maintaining the mucosal-to-mucosal apposition.
SPEAKER:
SPEAKER: The process is repeated for the contralateral ureter ileal anastomosis. In this final step, a barbed suture is used to under sew the proximal staple line to avoid contact of urine with the staples.
SPEAKER: A circumferential incision is made around the preplanned stoma site and carried down to the level of the fascia where cruciate incision is made. The peritoneum is entered, and an Alice clamp is used to grasp the distal the ileal conduit, which is held anatomically against the anterior abdominal wall. The abdomen is desufflated, allowing a length of the ileal conduit to be externalized safely, and the stoma is created in the usual fashion.
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