New technologies for old procedures when FireFly technologie improves Robotic Bladder Diverticulectomy
Scopo del Lavoro
The video shows the peculiar advantage of using Firefly Fluorescence Imaging da Vinci System during bladder diverticula detection and dissection.
Materiali e metodi
Patient is placed in the lithotomic position and 30° Trendelenburg. Supraumbilical camera trocar is inserted. We use a four-arm robotic approach and a 5 to 6 ports placements. Pneumoperitoneum is established at 12 Hg mm. The bladder is accessed via a transperitoneal route. We perform a flexible cystoscopy with the Firefly Fluorescence Imaging System on for the diverticulum detection. The peritoneum over the bladder is then incised to expose the diverticulum. We use this near-infrared technology also as a guide in the diverticulum dissection. Using sharp and blunt dissection, the diverticulum is resected to its neck. Completion of diverticulectomy and hydraulic tightness test. Drainage placement in the Retzius space and peritoneum reconstruction.
Several approaches have been described for intra-operative diverticulum identification and dissections. We developed a technique in which transperitoneal bladder diverticulectomy is performed under the Firefly guidance that provide real-time, image-guided identification of key anatomical landmarks.
In our experience, intra-operative use of Firefly makes identification and dissection of the diverticulum rapid, safe and effective with no additional cost, even in disadvantageous anatomic conditions such as lateral-posterior diverticula.