The laparoscopic radical cystoprostatectomy is a demanding surgical technique. The construction of a urinary diversion, conduit, or neobladder, is an even greater challenge due to its complexity and time-consuming nature, usually performed by laparotomy. The complete intracorporeal execution of the procedure is more common when supported by a robotic unit. The authors believe that performing the entire procedure intracorporeally increases the benefits of minimally invasive surgery, particularly the preservation of the intestine in a more controlled environment and the reduced aggression of the operative wound. The use of robotic/articulated laparoscopic instruments allows for a mobility of gestures closer to robotic units.

A patient with non-metastatic muscle-invasive bladder tumor who underwent neoadjuvant chemotherapy with cisplatin and gemcitabine was selected for this study. The patient underwent laparoscopic radical cystoprostatectomy with bilateral ileo-obturator lymphadenectomy and construction of a completely intracorporeal uretero-ileal conduit. Dex Surgical® robotic grasping forceps, Ligasure™ Maryland electro-surgical device, and the Signia™ (EndoGIA) stapling system was used in the surgery.

The surgery lasted for 290 minutes, with about two-thirds of the time spent on constructing the ileal conduit. Blood loss was measured at 350 ml. The postoperative period was uneventful, with discharge to the ward at 12 hours associated with early ambulation. The intestinal transit recovered at 36 hours, and the patient was discharged on the 11th day for social reasons. On the 20th day postoperatively, the patient had returned to their daily routine, showing signs of complete skin healing (final photo).

Minimally invasive techniques are now a universal practice and allow for early return of patients to their daily routines. While the proliferation of robotic surgery units is a reality in many countries, it is not the case in our own, and technological solutions that can improve the quality of surgery with less financial burden are an advantage. The authors believe that the use of robotic grasping forceps allowed for more precise suturing, therefore, better quality with less tissue stress induced by the manipulation of fewer structures, and faster suturing. Additionally, the intracorporeal construction of the conduit allowed for earlier resolution of postoperative ileus, a significantly smaller operative wound, with fewer painful complaints, and better patient tolerance. The use of these instruments is practical, and the ease of returning to classic instruments is an additional advantage.