Cadmore media player playing video Robotic female radical cystectomy
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
Robotic female radical cystectomy
Description:
Robotic female radical cystectomy
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/6e9a79e6-4c23-4edd-abcb-9474ce649a00/videoscrubberimages/Scrubber_4.jpg?sv=2019-02-02&sr=c&sig=t5c7%2FnAQ%2FZBvQh8KyvRwaLDxnurzi4MnNm%2BNaB95Q3Y%3D&st=2025-03-18T02%3A50%3A52Z&se=2025-03-18T06%3A55%3A52Z&sp=r
Duration:
T00H14M52S
Embed URL:
https://stream.cadmore.media/player/6e9a79e6-4c23-4edd-abcb-9474ce649a00
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/6e9a79e6-4c23-4edd-abcb-9474ce649a00/Cystectomy in a Female.mp4?sv=2019-02-02&sr=c&sig=LSZ2NiNCjuOI6YhFvaaFr6omz5txhFcHMA4GIfOalak%3D&st=2025-03-18T02%3A50%3A53Z&se=2025-03-18T04%3A55%3A53Z&sp=r
Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 INTRODUCTION.
HONG TRUONG: In this series of videos,
HONG TRUONG: we will demonstrate a stepwise approach to robotic cystectomy in woman with bladder cancer. We will cover both interior exenteration and pelvic organ-sparing approaches. Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer. Classical radical cystectomy in woman entails total anterior pelvic exenteration, including the removal of the bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, and the urethra.
HONG TRUONG: Since the early 2000s, adoption of orthotopic neobladder in woman in an effort to improve post-operative sexual and urinary function have motivated urologists to explore pelvic organ-sparing radical cystectomy, which refers to the preservation of the uterus, fallopian tubes, ovaries, anterior vagina, and urethra. The effort to preserve pelvic organs is supported by the fact that the incidence of direct involvement of the gynecological organs at the time of radical cystectomy is low, occurring in around 2.6% to 7.5% of women.
HONG TRUONG: In addition, pelvic organ-sparing radical cystectomy has been shown to improve voiding functions in patients undergoing orthotopic neobladder, better recovery of sexual function, and reduction in the incidence of neobladder-vaginal fistula. The most important factor in choosing to preserve organs is that cancer control is not compromised. Therefore, patient selection is paramount.
HONG TRUONG: To be considered for organ-sparing radical cystectomy, patient must have non-palpable tumor on bimanual exam. There must be no preoperative hydronephrosis and no tumor involvement at the bladder base, trigone, or bladder neck. We use the standard six-port configuration for robotic cystectomy as shown in this figure. The surgical assistant is positioned on the patient's left side.
HONG TRUONG: An overview of the steps of the operation are displayed. We include both classical anterior exenteration and pelvic organ-sparing radical cystectomy approach and relevant steps. We will also present techniques of pelvic floor reconstruction, especially for patients who will undergo orthotopic neobladder.
Segment:2 MOBILIZATION AND DIVISION OF THE URETERS.
HONG TRUONG: We begin by identifying the ureters at the course
HONG TRUONG: of the common iliac arteries.
HONG TRUONG: The overlying peritoneum is incised, and the right ureter is mobilized toward the bladder. Care is taken to preserve periurethral vascularity during mobilization. As the ureter is dissected distally, the annexa are lifted [INAUDIBLE] along with the infundibular pelvic expansionary ligament. The ureter is mobilized distally to the level of the uterine artery.
HONG TRUONG: In this view, one can appreciate the right pelvic vasculature in relationship to the ureter, the common iliac, and hypogastric arteries are visible. Emanating from the hypogastric artery, the uterine and superior vesicle arteries are seen. The uterine artery courses medially directly over the ureter. At this level, the ureter can be divided. [INAUDIBLE] and dissection of the left ureter proceeds in similar fashion.
HONG TRUONG: Again, the left uterine artery is seen as it courses medially over the left ureter. The ureter is subsequently divided between two Hem-O-Lok clips.
Segment:3 POSTERIOR DISSECTION OF THE BLADDER.
HONG TRUONG: Following dissection of both ureters, attention is turned toward the midline. From this view, the relative position of the pelvic organs is readily displayed.
HONG TRUONG: The bladder is seen caudal to the uterus and is highlighted in yellow. The uterus, along with the [INAUDIBLE] and broad ligaments, are illustrated. The ovaries, fallopian tubes, and infundibular pelvic ligaments are seen as they course superior laterally. The plane between the anterior vagina and posterior bladder is developed by first incising the peritoneum overlying the vesicle uterine pouch.
HONG TRUONG: Soft tissue attachments are divided using a combination of shock and blunt dissection. The bladder is lifted away from the anterior vagina, taking care to remain in the intervening fibrofatty plane. Next, with the uterus anteverted, the infundibular ligament, the ovarian pedicle, and the broad ligaments are identified and divided with robotic vessel sealer.
HONG TRUONG: The lateral perivaginal space is developed. The uterine arteries are ligated with locking clips and divided. With the aid of an EEA sizer in the vagina, the uterine fundus is transected at the posterior fornix at the level of the cervical insertion.
HONG TRUONG: The vaginal wall can be divided with electrocautery at the level of the bladder neck. For pelvic organ-sparing radical cystectomy, the uterus and its vascular pedicles are spared. This view of the right perivaginal dissection demonstrates the right vascular pedicle to the bladder, cardinal ligament containing the right uterine artery, and the distal ureter crossing underneath.
HONG TRUONG: The previously clipped and dissected urethral stump is [INAUDIBLE] free and delivered under the uterine artery as the cardinal ligament is preserved. Limited dissection of the uterus is performed posteriorly, leaving the uterosacral ligament undisturbed.
Segment:4 DIVISION OF THE BLADDER PEDICLES.
HONG TRUONG: Attention is now directed toward the division of the vascular pedicles to the bladder. Proceeding laterally to medially, the previously identified left lateral pedicle to the bladder is divided using vessel sealer.
HONG TRUONG: Branches from the inferior pedicle are identified, separated into a packet, clipped, and divided. The right lateral bladder pedicle is similarly controlled and transected. Connective tissue attachment, a small perforated vessel, can be taken now using robotic vessel sealer. The dissection posteriorly proceeds to the level of the bladder neck.
HONG TRUONG:
Segment:5 ANTERIOR DISSECTION OF THE BLADDER.
HONG TRUONG: Anterior dissection of the bladder begins with dividing the median umbilical ligament as proximally as possible.
HONG TRUONG: The dissection is carried caudally over the anterior surface of the bladder to the pubic symphysis to develop the space [INAUDIBLE].. The location of the bladder neck can be identified using the balloon of the Foley catheter. Connective tissue attachment is separated using shock dissection and limited electrocautery. The dorsal venous complex anterior to the urethra is divided sharply.
HONG TRUONG: Complete urethrectomy can be performed intracorporeally. If an orthotopic neobladder is planed, care is taken here to preserve the endopelvic fascia and supporting periurethral attachment investing the distal third of the urethra in order to optimize continence.
HONG TRUONG: The urethra is transected sharply without electrocautery just distal to the bladder neck to ensure preservation of a functional urethral stump. Once the urethra is transected, a frozen section should be taken from the proximal portion of the divided urethra before creation of a neobladder. Inner view of the pelvis after the specimen is removed demonstrates robust urethral stump, preservation of the endopelvic fascia, and pupa urethral ligament, sparing of the anterior vagina, uterus, and annexa with supporting ligaments intact.
Segment:6 VAGINAL RECONSTRUCTION.
HONG TRUONG: The next three videos demonstrate our techniques of vaginal reconstruction, a step that can be taken to minimize risks of neobladder, vaginal fistula, and bowel herniation. Some posterior dissection of the vagina may be necessary to bring the posterior vaginal wall toward the anterior remnants for closure.
HONG TRUONG: The vaginal closure should be performed in a clamp-style fashion with two layers of running interlocking sutures. Avoid rolling the posterior vaginal wall into a tube in an attempt to preserve length. This approach has a high likelihood of breakdown or being too narrow for intercourse. We typically start the closure at the midline and proceed from medial to lateral aspect.
HONG TRUONG:
Segment:7 PEDICLED OMENTAL FLAP.
HONG TRUONG: A pedicle omental flap can be harvested
HONG TRUONG: to reinforce the vaginal closure and act as an interposing layer between the vaginal stump and the urethral ileal anastomosis, especially in the case of prior pelvic radiation. The greater omentum is dissected from the transverse colon and greater curvature of the stomach with robotic vessel sealer to form an omental flap based on the right or the left gastroepiploic artery.
HONG TRUONG: The flap is tunneled to the pelvic floor And secured to the endopelvic fascia with absorbable sutures.
Segment:8 SACROCOLPOPEXY.
HONG TRUONG: In patients with prior hysterectomy or those required classical radical cystectomy, the removal of reproductive organs and their supporting tissue may result in a weakening of the pelvic floor and put patients at risk for bowel herniation.
HONG TRUONG: Concomitant sacrocolpopexy after radical cystectomy can be performed to improve post-operative functions. A y-shaped, soft polypropylene mesh is used for the sacrocolpopexy with the aid of an EEA sizer to identify the apex of the vagina. The posterior leaflet of the mesh is secured to the posterior remnant of the vagina using running absorbable sutures.
HONG TRUONG: The interior liplet of the mesh is sutured to the anterior remnant of the vagina in similar fashion. Care must be taken to avoid excessive tensions of the mesh. The tail of the mesh is secured to the anterior spinous ligament at the level of sacral promontory using interrupted non-absorbable sutures, such as GORE-TEX. Avoid suturing middle sacral vessel traversing over the promontory, which could cause a lot of bleeding in this area.
HONG TRUONG: The peritoneum is then closed to cover the mesh.
Segment:9 OUTCOMES.
HONG TRUONG: Retrospective data on oncologic, urinary, and sexual outcomes in women undergoing pelvic organ-sparing radical cystectomy is summarized in the table below. In appropriately selected patients with accurate clinical staging, pelvic organ-sparing radical cystectomy does not compromise oncologic control.
HONG TRUONG: Functional advantages of pelvic organ-sparing approach includes, improved sexual function and satisfaction, as well as bed-avoiding function in patients with orthotopic neobladder.
Segment:10 CONCLUSION.
HONG TRUONG: In conclusion, preservation of female reproductive organs is feasible during robotic cystectomy in carefully selected patients with accurate clinical staging. Pelvic organ-sparing radical cystectomy can optimize post-operative quality of life while not compromising cancer control.
HONG TRUONG: Further data from prospective studies are needed to understand the impact of quality of life and long term cancer-specific outcomes in patients undergoing pelvic organ-sparing radical cystectomy to safely conclude about a broader use of this approach.
Segment:1 INTRODUCTION.
HONG TRUONG: In this series of videos,
HONG TRUONG: we will demonstrate a stepwise approach to robotic cystectomy in woman with bladder cancer. We will cover both interior exenteration and pelvic organ-sparing approaches. Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer. Classical radical cystectomy in woman entails total anterior pelvic exenteration, including the removal of the bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, and the urethra.
HONG TRUONG: Since the early 2000s, adoption of orthotopic neobladder in woman in an effort to improve post-operative sexual and urinary function have motivated urologists to explore pelvic organ-sparing radical cystectomy, which refers to the preservation of the uterus, fallopian tubes, ovaries, anterior vagina, and urethra. The effort to preserve pelvic organs is supported by the fact that the incidence of direct involvement of the gynecological organs at the time of radical cystectomy is low, occurring in around 2.6% to 7.5% of women.
HONG TRUONG: In addition, pelvic organ-sparing radical cystectomy has been shown to improve voiding functions in patients undergoing orthotopic neobladder, better recovery of sexual function, and reduction in the incidence of neobladder-vaginal fistula. The most important factor in choosing to preserve organs is that cancer control is not compromised. Therefore, patient selection is paramount.
HONG TRUONG: To be considered for organ-sparing radical cystectomy, patient must have non-palpable tumor on bimanual exam. There must be no preoperative hydronephrosis and no tumor involvement at the bladder base, trigone, or bladder neck. We use the standard six-port configuration for robotic cystectomy as shown in this figure. The surgical assistant is positioned on the patient's left side.
HONG TRUONG: An overview of the steps of the operation are displayed. We include both classical anterior exenteration and pelvic organ-sparing radical cystectomy approach and relevant steps. We will also present techniques of pelvic floor reconstruction, especially for patients who will undergo orthotopic neobladder.
Segment:2 MOBILIZATION AND DIVISION OF THE URETERS.
HONG TRUONG: We begin by identifying the ureters at the course
HONG TRUONG: of the common iliac arteries.
HONG TRUONG: The overlying peritoneum is incised, and the right ureter is mobilized toward the bladder. Care is taken to preserve periurethral vascularity during mobilization. As the ureter is dissected distally, the annexa are lifted [INAUDIBLE] along with the infundibular pelvic expansionary ligament. The ureter is mobilized distally to the level of the uterine artery.
HONG TRUONG: In this view, one can appreciate the right pelvic vasculature in relationship to the ureter, the common iliac, and hypogastric arteries are visible. Emanating from the hypogastric artery, the uterine and superior vesicle arteries are seen. The uterine artery courses medially directly over the ureter. At this level, the ureter can be divided. [INAUDIBLE] and dissection of the left ureter proceeds in similar fashion.
HONG TRUONG: Again, the left uterine artery is seen as it courses medially over the left ureter. The ureter is subsequently divided between two Hem-O-Lok clips.
Segment:3 POSTERIOR DISSECTION OF THE BLADDER.
HONG TRUONG: Following dissection of both ureters, attention is turned toward the midline. From this view, the relative position of the pelvic organs is readily displayed.
HONG TRUONG: The bladder is seen caudal to the uterus and is highlighted in yellow. The uterus, along with the [INAUDIBLE] and broad ligaments, are illustrated. The ovaries, fallopian tubes, and infundibular pelvic ligaments are seen as they course superior laterally. The plane between the anterior vagina and posterior bladder is developed by first incising the peritoneum overlying the vesicle uterine pouch.
HONG TRUONG: Soft tissue attachments are divided using a combination of shock and blunt dissection. The bladder is lifted away from the anterior vagina, taking care to remain in the intervening fibrofatty plane. Next, with the uterus anteverted, the infundibular ligament, the ovarian pedicle, and the broad ligaments are identified and divided with robotic vessel sealer.
HONG TRUONG: The lateral perivaginal space is developed. The uterine arteries are ligated with locking clips and divided. With the aid of an EEA sizer in the vagina, the uterine fundus is transected at the posterior fornix at the level of the cervical insertion.
HONG TRUONG: The vaginal wall can be divided with electrocautery at the level of the bladder neck. For pelvic organ-sparing radical cystectomy, the uterus and its vascular pedicles are spared. This view of the right perivaginal dissection demonstrates the right vascular pedicle to the bladder, cardinal ligament containing the right uterine artery, and the distal ureter crossing underneath.
HONG TRUONG: The previously clipped and dissected urethral stump is [INAUDIBLE] free and delivered under the uterine artery as the cardinal ligament is preserved. Limited dissection of the uterus is performed posteriorly, leaving the uterosacral ligament undisturbed.
Segment:4 DIVISION OF THE BLADDER PEDICLES.
HONG TRUONG: Attention is now directed toward the division of the vascular pedicles to the bladder. Proceeding laterally to medially, the previously identified left lateral pedicle to the bladder is divided using vessel sealer.
HONG TRUONG: Branches from the inferior pedicle are identified, separated into a packet, clipped, and divided. The right lateral bladder pedicle is similarly controlled and transected. Connective tissue attachment, a small perforated vessel, can be taken now using robotic vessel sealer. The dissection posteriorly proceeds to the level of the bladder neck.
HONG TRUONG:
Segment:5 ANTERIOR DISSECTION OF THE BLADDER.
HONG TRUONG: Anterior dissection of the bladder begins with dividing the median umbilical ligament as proximally as possible.
HONG TRUONG: The dissection is carried caudally over the anterior surface of the bladder to the pubic symphysis to develop the space [INAUDIBLE].. The location of the bladder neck can be identified using the balloon of the Foley catheter. Connective tissue attachment is separated using shock dissection and limited electrocautery. The dorsal venous complex anterior to the urethra is divided sharply.
HONG TRUONG: Complete urethrectomy can be performed intracorporeally. If an orthotopic neobladder is planed, care is taken here to preserve the endopelvic fascia and supporting periurethral attachment investing the distal third of the urethra in order to optimize continence.
HONG TRUONG: The urethra is transected sharply without electrocautery just distal to the bladder neck to ensure preservation of a functional urethral stump. Once the urethra is transected, a frozen section should be taken from the proximal portion of the divided urethra before creation of a neobladder. Inner view of the pelvis after the specimen is removed demonstrates robust urethral stump, preservation of the endopelvic fascia, and pupa urethral ligament, sparing of the anterior vagina, uterus, and annexa with supporting ligaments intact.
Segment:6 VAGINAL RECONSTRUCTION.
HONG TRUONG: The next three videos demonstrate our techniques of vaginal reconstruction, a step that can be taken to minimize risks of neobladder, vaginal fistula, and bowel herniation. Some posterior dissection of the vagina may be necessary to bring the posterior vaginal wall toward the anterior remnants for closure.
HONG TRUONG: The vaginal closure should be performed in a clamp-style fashion with two layers of running interlocking sutures. Avoid rolling the posterior vaginal wall into a tube in an attempt to preserve length. This approach has a high likelihood of breakdown or being too narrow for intercourse. We typically start the closure at the midline and proceed from medial to lateral aspect.
HONG TRUONG:
Segment:7 PEDICLED OMENTAL FLAP.
HONG TRUONG: A pedicle omental flap can be harvested
HONG TRUONG: to reinforce the vaginal closure and act as an interposing layer between the vaginal stump and the urethral ileal anastomosis, especially in the case of prior pelvic radiation. The greater omentum is dissected from the transverse colon and greater curvature of the stomach with robotic vessel sealer to form an omental flap based on the right or the left gastroepiploic artery.
HONG TRUONG: The flap is tunneled to the pelvic floor And secured to the endopelvic fascia with absorbable sutures.
Segment:8 SACROCOLPOPEXY.
HONG TRUONG: In patients with prior hysterectomy or those required classical radical cystectomy, the removal of reproductive organs and their supporting tissue may result in a weakening of the pelvic floor and put patients at risk for bowel herniation.
HONG TRUONG: Concomitant sacrocolpopexy after radical cystectomy can be performed to improve post-operative functions. A y-shaped, soft polypropylene mesh is used for the sacrocolpopexy with the aid of an EEA sizer to identify the apex of the vagina. The posterior leaflet of the mesh is secured to the posterior remnant of the vagina using running absorbable sutures.
HONG TRUONG: The interior liplet of the mesh is sutured to the anterior remnant of the vagina in similar fashion. Care must be taken to avoid excessive tensions of the mesh. The tail of the mesh is secured to the anterior spinous ligament at the level of sacral promontory using interrupted non-absorbable sutures, such as GORE-TEX. Avoid suturing middle sacral vessel traversing over the promontory, which could cause a lot of bleeding in this area.
HONG TRUONG: The peritoneum is then closed to cover the mesh.
Segment:9 OUTCOMES.
HONG TRUONG: Retrospective data on oncologic, urinary, and sexual outcomes in women undergoing pelvic organ-sparing radical cystectomy is summarized in the table below. In appropriately selected patients with accurate clinical staging, pelvic organ-sparing radical cystectomy does not compromise oncologic control.
HONG TRUONG: Functional advantages of pelvic organ-sparing approach includes, improved sexual function and satisfaction, as well as bed-avoiding function in patients with orthotopic neobladder.
Segment:10 CONCLUSION.
HONG TRUONG: In conclusion, preservation of female reproductive organs is feasible during robotic cystectomy in carefully selected patients with accurate clinical staging. Pelvic organ-sparing radical cystectomy can optimize post-operative quality of life while not compromising cancer control.
HONG TRUONG: Further data from prospective studies are needed to understand the impact of quality of life and long term cancer-specific outcomes in patients undergoing pelvic organ-sparing radical cystectomy to safely conclude about a broader use of this approach.
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode