Robotic Anterior Pelvic Exenteration for Bladder Cancer in Patient with Previous Kidney-Pancreas Transplant

OBJECTIVE - To demonstrate the feasibility of robotic anterior pelvic exenteration with intracoporeal ileal conduit for bladder cancer in a patient with previous renal and pancreas allograft transplantion (KTP).

METHODS - Technical considerations included avoiding injury to transplant graft, minimizing devascularization of transplant ureter, intracorporeal mobilization of bowel with pancreas graft, and positioning of ileal conduit. Surgical approach required multi-disciplinary approach for surgical planning and medical management.

RESULTS - The patient's pre-operative serum creatinine was 1. 22 ng/mL and was unchanged at 1-month following surgery at 1. 21 ng/mL. Total robotic console time was 4 hours and 21 minutes and estimated blood loss is 30 cc. There were no intraoperative complications. Final pathology demonstrated pT1N0 high-grade multifocal micropappilary urothelial cell carcinoma with carcinoma in situ, and all surgical margins were negative.

CONCLUSIONS - Robotic anterior pelvic exenteration with intracorporeal urinary diversion for bladder cancer in patient with previous KTP is challenging but a feasible surgical technique, which requires a multidisciplinary team and a low threshold to convert to open surgery.

Urology. 2015 Dec 29 [Epub ahead of print]

Yaw A Nyame, Naveen Nandanan, Daniel J Greene, Venkatesh Krishnamurthi, Georges-Pascal Haber

Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, 44106, USA. , Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, 44106, USA. , Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, 44106, USA. , Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, 44106, USA. , Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, 44106, USA. 

PubMed