title: Robotic bladder diverticulectomy: technique and surgical outcomes.
abstract: OBJECTIVE
  Indications for surgical treatment of bladder diverticula include tumor, lower urinary tract symptoms refractory to medical treatment, renal dysfunction or recurrent urinary tract infections. We describe the technique and report the outcomes of robotic bladder diverticulectomy at our institution.
  
  
  METHODS
  A chart review of patients who underwent robotic bladder diverticulectomy at our institution from 2007 to 2010 was carried out. Indications for the procedure were: lower urinary tract symptoms (LUTS) not responding to medical treatment (2 patients), ureteral obstruction (1 patient), tumor arising in a diverticulum (2 patients) and diverticulum secondary to neurogenic bladder (1 patient). One patient also had renal dysfunction associated with ureteral insertion into the diverticulum and therefore underwent ipsilateral ureteroneocystostomy. Other additional procedures included transurethral resection of the prostate (1 patient) and bilateral pelvic lymph node dissection (1 patient). Perioperative and postoperative outcomes were analyzed.
  
  
  RESULTS
  Six patients (median age 61.5 years, range 19-75) underwent da Vinci diverticulectomy using a transperitoneal approach without the need for open conversion. Median operative time was 232 min (135-360 min.). Median estimated blood loss was 100 mL (50-150 mL). The Foley catheter was removed after a negative cystogram and median time to catheter removal was 7 days (7-12 days). Median hospital stay was 3 days (2-5 days). The only complication was a urinary tract infection managed with antibiotics.
  
  
  CONCLUSIONS
  Robotic surgery represents a reasonable minimally invasive treatment option for resection of bladder diverticula when indicated.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Neil S
authors.initials: NS
authors.lastname: Patel
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004240:Diverticulum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000002:abnormalities* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult