Robotic-assisted Laparoscopic Repair of a Penetrating Extraperitoneal Bladder Injury.

BACKGROUND

Traumatic intraperitoneal or complicated extraperitoneal bladder injuries are conventionally managed with open exploration and repair. There are rare reports in the literature of laparoscopic repair of intraperitoneal bladder injury secondary to blunt abdominal trauma, as well as two reports of laparoscopic repair of extraperitoneal bladder injuries from blunt abdominal trauma. There are no reported cases of a minimally invasive surgical repair of a penetrating bladder injury. There are also no reported cases of a robotic-assisted laparoscopic repair of a traumatic bladder injury, regardless of the injury mechanism.

OBJECTIVE

In this video, we demonstrate a surgical technique for a robotic-assisted laparoscopic repair of a penetrating traumatic bladder injury.

METHODS

We present a case of a 43-year-old male with a penetrating extraperitoneal bladder injury secondary to a gunshot wound. Our patient underwent emergent primary vascular repair of an associated vascular injury. Hemodynamic instability delayed immediate exploration and bladder repair. Cross-sectional imaging and flexible sigmoidoscopy ruled out further visceral injury. Unfortunately, difficulty maintaining catheter patency prompted further surgical intervention. An attempt to evacuate all clots by rigid cystoscopy was unsuccessful, and the decision was made to proceed with a robotic-assisted laparoscopic cystorrhaphy.

RESULTS

The retropubic space was developed and the extraperitoneal bladder injury was identified. All clot was evacuated and no active bleeding was noted. The bladder mucosa was inspected confirming no additional injury. The cystotomy was closed in two running layers using absorbable sutures. Two leak tests were performed confirming a water-tight repair. The bladder was reapproximated to the anterior abdominal wall to reestablish the retropubic space. A cystogram 1week postoperatively confirmed a successful bladder repair.

CONCLUSION

Robotic-assisted laparoscopic cystorrhaphy may be a feasible approach for a penetrating extraperitoneal bladder injury in highly select, hemodynamically stable patients.