Transvesical Approach in Robot-Assisted Bladder Diverticulectomy: Surgical Technique and Outcome

Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach

“…Similar to traditional open surgery, the transvesical and extravesical approaches are the most frequently used by robotic surgeons [8] , [13] , [16] . In rare cases, some authors have proposed a transdiverticular approach for very large BD, whereby the sac can be opened, entered, and subsequently followed until the diverticular neck is found [7] .…”

“…Liu et al [7] proposed the transvesical technique for posterior or posterolateral BD often located in close proximity to the ureteric orifice, and, vice versa, the extravesical approach for moderate to large BD located near the dome of the bladder or at the lateral wall. Develtere et al [8] adopted the transvesical route for all their cases, claiming that this technique allows rapid identification of the BD neck and ureteral orifices, and facilitates concomitant simple prostatectomy or bladder stone removal when necessary. In our experience, the extravesical approach allowed appropriate treatment of all the posteriorly or posterolaterally located BD.…”

“…The type and timing of treatment to relieve BOO/BPE in patients undergoing RABD is not yet standardised, with 30–65% undergoing a concomitant procedure, either transurethral resection (or enucleation) of prostate adenoma or RASP [6] , [7] , [8] , [17] , [18] . In our series, 56% of patients underwent concomitant bipolar TURP, namely those with prostate volume <60 cm 3 .…”

“…After the initial case described by Berger et al in 2006 [5] , fewer than 80 robotic cases were reported in the literature up to 2018, with the majority of series including five or fewer cases [6] . Very recently, Liu et al [7] and Develtere et al [8] reported on the largest robotic series in the literature, consisting of 20 (including two for an intradiverticular urothelial cancer) and 23 cases, respectively. Notably, in the study by Liu et al [7] , the robotic approach was associated with better perioperative outcomes in comparison to the open strategy.…”

Multiple Bladder Diverticula Presenting in an 82-Year-Old Congolese Male

“…Actually, the robotic surgery has revolutionized the management of bladder diverticula [19]. The robot-assisted transvesical diverticulectomy is accompanied by some advantages: quick localization of the diverticulum and orifices, direct access to the prostate when simultaneous desobstruction is necessary, and short catheterization time [20,21].…”