Robotic Orthotopic Neobladder: The Two Chimney Technique

Abstract

Bladder substitution following radical cystectomy for urothelial cancer (transitional cell carcinoma) has become increasingly common and in many centers has evolved to become the standard method of urinary diversion. Orthotopic neobladder has been a commonly used option for urinary diversion since the 1980s. Advantages of this type of diversion are the ability to avoid an ostomy, voiding function similar to the native bladder, and improved cosmesis. Robotic intracorporeal neobladder creation has demonstrated similar outcomes to open technique and represents a promising minimally invasive diversion for the future. The Studer pouch is widely used nowadays, yet there are still some drawbacks. Therefore, we designed a technique that would offer an orthotopic ureteroileal anastomosis by using a two chimney modification. This modification is simple to handle, safe and free of ureteric stricture or reflux. With low stricture rates, this modified procedure of ureterointestinal anastomosis, is worthy of further promotion.

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

“…The Kock ileal neobladder, described first in 1982, is based on the Kock pouch and recalls the same surgical technique, presenting two limbs of 17 cm, isolated 20 cm proximally to the ileocecal valve with a reservoir shaped in a spherical manner, utilizing 44 cm of small bowel [102,103].…”