Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: surgical technique, perioperative and early functional outcomes of a prospective single center series

Giuseppe Simone1, Salvatore Guaglianone1, Francesco Minisola1, Mariaconsiglia Ferriero1, Leonardo Misuraca1, Gabriele Tuderti1, Michele Gallucci1
  • 1 Istituto Nazionale Tumori "Regina Elena", Unità di Urologia (Roma)


In this prospective study ( NCT02665156) we assessed the feasibility, safety and time efficiency of RARC with intracorporeal partly stapled “Padua Ileal Bladder” using robotic staplers.
Twenty-two consecutive patients with muscle invasive or high grade recurrent urothelial bladder carcinoma were treated between March 2016 and October 2016. Baseline, perioperative and follow-up data were prospectively collected. Key steps of surgery include: selection of 45 centimeters of ileum and division of the distal and proximal part of the ileum using robotic staplers; detubularization of the ileal loop; creation of the neo-bladder neck with one stapler load; double folding of the proximal ileal loop using two-three stapler loads; hand-sewing of the posterior neobladders wall with barbed suture; uretero-ileal anastomoses on JJ stents with a modified split-nipple technique; urethroneobladder anastomosis is performed according to Van Velthoven; hand-sewing of the anterior neobladders wall with barbed suture.
Median total operative time (“skin to skin”) was 270 minutes (IQR:255-295).
Median hospital stay was 9 days (IQR 8-11). Overall complication rate was 40.1% and overall severe complication incidence was 18.2%; at a median follow-up of 3 months, no patients developed recurrence, daytime continence rate was 59%.
We first report safety, feasibility and time efficiency in the use of robotic staplers to create orthotopic neobladder.