Abstract
Clinical History:
A 72-year-old man presented 6 months after robotic radical cystoprostatectomy and ileal conduit (IC) for urothelial carcinoma of the bladder, with recurrent infections and large particulates in his urostomy bag.
Physical Exam:
The IC appeared normal with seeds and pieces of carrot noted in his urostomy bag.
Diagnosis:
Computed tomography loopogram demonstrated contrast within the adjacent small bowel, with a small amount of air between the IC and bowel, suggestive of an IC-enteric fistula.
Intervention:
Robot-assisted laparoscopic fistula takedown was performed. The patient was positioned supine, a Foley catheter was placed into the IC, and robotic ports were positioned superior and left of the conduit. Indocyanine green was injected retrograde into the IC via a Foley catheter. With the use of Firefly fluorescence, the fistulous tract connecting to the small bowel anastomosis was visualized. This facilitated dissection to isolate the fistula and targeted stapling of the proximal and distal ends. The IC staple line was excised, the conduit was closed with absorbable suture, and omental interposition was performed. Intraoperative leak test was negative.
Follow-Up/Outcomes:
The patient was discharged on postoperative day 2 without complications. At the 4-month follow-up, he was doing well with no recurrence of fistula.
Music:
Background music is “Hip Jazz” by Bensound.com. This work is licensed as royalty-free music and is used with permission under Bensound’s terms.
Patient Consent Statement:
Authors have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.
Author Disclosure Statement:
The authors declare no conflicts of interest.
Funding Statement:
No funding was received for this work.
Source of Work:
This work was performed at Loma Linda University Medical Center, Loma Linda, CA.
Runtime of video:
4 mins 58 secs.
Keywords