Robotic-assisted Bladder Diverticulectomy: Assessment of Outcomes and Modifications of Technique.

Objective To present outcomes of robotic-assisted bladder diverticulectomy (RABD) and technique modifications that may improve outcomes. Methods Sixteen consecutive RABDs were performed at our institution by 2 experienced robotic surgeons. Charts were reviewed for patient characteristics, perioperative data, and long-term functional outcomes. Eleven patients (69%) underwent RABD using an external dissection approach, whereas 5 patients (31%) underwent RABD using a modified internal dissection technique (immediate entry into the bladder diverticulum). Results The mean age of our cohort was 68 years (range, 59-79 years), and 15 of 16 patients (93.8%) were men. Two patients (12.5%) had known malignancy in the diverticulum. Eleven patients (69%) underwent a preoperative outlet procedure (9 transurethral resection of prostate and 2 transurethral incision of prostate) at a median time before RABD of 163.5 days (range, 26-622 days). Median operative time for external RABD was 228 minutes (range, 144-353 minutes) compared with that of 149 minutes (range, 130-189 minutes) for the internal dissection technique. No patient required blood transfusions, and there were no 30-day Clavien grade 3 or 4 complications. Median hospital stay was 2 days (range, 1-3 days). Median postvoid residual before intervention was 458 mL (range, 78-1100 mL) compared with that of 214 mL (range, 46-527 mL) after RABD. Mean American Urological Association symptom score was 18 (range, 5-29) preoperatively compared with that of 7 (range, 2-21) postoperatively. Conclusion RABD is safe with a low risk of intraoperative or postoperative complications and results in both improved voiding symptoms and diminished postvoid residuals. Modifications of technique from an external dissection approach to an internal dissection approach has led to a dramatic reduction in operative time.