Robotic Extramucosal Excision of Bladder Wall Leiomyoma

Abstract

_______________________________________________________________________________________Introduction: Multiple case reports and reviews have been described in the literature for bladder wall leiomyoma resection via different approaches. The minimally invasive partial cystectomy remains the most widely accepted technique; however, case reports for enucleation of bladder wall leiomyoma have also been described. The purpose of this video is to demonstrate the robotic extramucosal excision of a bladder wall leiomyoma, without cystotomy, but with complete removal of the muscular layer. Materials and Methods: A 35-year old male present with lower urinary tract symptoms and imaging showed bladder wall mass with histopathology showed leiomyoma. The patient consented for mass excision with the possibility of a partial cystectomy. The patient was placed in the supine, 30-degree Trendelenburg position during the procedure. A total of 4 ports were inserted. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. Extramucosal excision was accomplished without cystotomy and muscle approximation was achieved by 2 0 Vicryle. Result: The operative time was 90 minutes, blood loss of approximately 50mL and the patient was discharged after 72 hours with no immediate complications and a 6 months follow-up showed no recurrence. Conclusion: Such a technique results in complete excision of the tumor, without cystotomy, and also maintains an intact mucosa. These steps, in addition to decreasing the risk of local recurrence, also shorten the period of postoperative catheterization and hospitalization.

Open Surgery Following Endourological Treatment in Leiomyoma of the Bladder: Case Report

“…Furthermore, there are reports of laparoscopic and robotic surgery in the literature. 18 For large tumors, on the other hand, partial cystectomy should be evaluated as a surgical treatment option. 5 In addition, some giant leiomyomas may require cystoprostatectomy and ileal conduit urinary diversion.…”

Incidental Urinary Bladder Leiomyoma: A Successful Long Term Conservative Treatment Based on Pre-operatory Magnetic Resonance Imaging Findingsr

“…The treatment, which is almost always surgical, is strongly associated with the tumour burden, and range from TURB for smaller tumours to open surgical excision or radical cystectomy for larger ones. Minimally invasive surgeries, such as laparoscopic surgery and robot-assisted excision, have been described as well [10,[23][24][25][26][27]. Also given the young age of the patient, an extremely accurate preoperative diagnosis was of utmost importance to plan the most conservative treatment.…”