Robot-assisted radical cystectomy with intracorporeal ileal conduit formation: Step-by-step technique developed at the “Kommunarka” Moscow Multidisciplinary Clinical Center

Background. Radical cystectomy (RC) is a key method of treatment of muscle-invasive bladder cancer. Laparoscopic and robot-assisted approaches allow to achieve good oncological results while minimizing injury and thus improving functional results.

Aim. To describe the technique of robot-assisted RC developed and validated at the “Kommunarka” Moscow Multidisciplinary Clinical Center, Moscow Healthcare Department.

Description of the technique. Robot-assisted RC is performed with intracorporeal formation of an ileal conduit per Bricker without intubation of the ureter. After standard installation of the ports, mobilization of the ureter with sparing of the periureteral cellular tissue is performed. Extended pelvic lymph node dissection is performed. Distal parts of the ureters are clipped and dissected. After complete en bloc mobilization of the bladder and prostate with seminal vesicles, umbilical ligaments and puboprostatic ligaments are dissected, and endopelvic fascia is opened. After completion of dissection of the apical part of the prostate, a clamp is placed on the urethra, and it is dissected. The system is de-docked, the angle of the operating table is changed from 45° to 15°, and an accurate aiming of surgical instruments at the ileocecal angle is performed. After mobilization of the left ureter, it is moved from left to right through the previously formed tunnel in the sigmoid mesocolon. At the distance of 15–20 cm from the ileocecal angle, part of the ilium with mesentery is mobilized. Mesentery is dissected and intestine is resected. Side-to-side intestinal anastomosis is formed. Intestinal segment is placed isoperistaltically, and mesentery “window” is sutured. Distal parts of the ureters are dissected, and end-to-side uretero-enteric anastomosis is formed (per Nesbit technique). Ileal conduit is moved to the anterior abdominal wall. The surgery ends with draining of the pelvis.

Discussion. According to literature data, not performing upper urinary tract draining using external ureteral stents does not increase the rate of complications. Prospective study of safety and efficacy of cystectomy without ureter intubation has been ongoing at the “Kommunarka” Moscow Multidisciplinary Clinical Center, Moscow Healthcare Department since 2024.

Conclusion. The described robot-assisted RC technique with intracorporeal formation of Bricker ileal conduit without placing stents in the ureters can be considered a standard of bladder cancer treatment in conditions of availability of a highly qualified surgical brigade. The article presents a step-by-step description which will help practicing doctors to learn the technique of this complicated intervention.

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