**5.3 Neo-bladder creation**

The creation of a Y-neobladder intra-corporeal technique following from the Clinique Saint-Augustin is described and showed step by step. The neobladder

**Figure 10.** *Left side ureter and prostate fascia.*

**Figure 11.** *Endopelvic fascia and ligaments preserved.*

**Figure 12.** *Ileal segment and urethra-ileal anastomosis.*

creation goes by selecting a 40 cm ileal segment form 15 to 20 cm proximal to the ileocecal valve. The segment is arranged in a modified Y shape [22]. The ileal segment is approximate to the urethra for an anastomosis (**Figure 12**).

The continuity of the bowel is achieved with a latero-lateral ileal anastomosis. Our group prefers to use a robotic Da Vinci system stapler, if not available, a laparoscopic stapler could be used trough the 15 mm assistant-trocar (**Figure 13**).

Detubularization of the bowel starts for the two ileal limbs in the antimesenteric border. Construction of the posterior plate is performed by suturing the medial edges of the detubularized limbs (**Figure 14**).

The proximal part of the posterior plate is folded anteriorly and suture for the creation of the anterior wall, the lateral windows are closed with running sutures (**Figure 15**) [22, 23].

The ureter is spatulated and implanted over the proximal end of both ileal limbs without antireflux technique independently with two plates running suture (**Figure 16**).

The neobladder is tested by the instillation of 500 cc of saline by the definitive catheter. A drain is place in the left side of the cavity and the specimen is extracted at the end of the procedure via a 5 cm midline incision [22, 23].

*Robot-Assisted Radical Cystectomy with Intra-Corporeal Neo-Bladder DOI: http://dx.doi.org/10.5772/intechopen.98973*

**Figure 13.** *Latero-lateral ileal anastomosis.*

**Figure 14.** *Detubularization and posterior plate.*

**Figure 15.** *Proximal part folded. Lateral close to create the neobladder.*

**Figure 16.** *Ureteral ileal anastomosis.*
