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International braz j urol

Print version ISSN 1677-5538

Int. braz j urol. vol.40 no.1 Rio de Janeiro Jan./Feb. 2014 

Video Section

Robotic Extramucosal Excision of Bladder Wall Leiomyoma

Khalid E. Al-Othman

Emad S. Rajih

Mohammed F. Al-Otaibi

1King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia



Multiple case reports and reviews have been described in the literature for bladder wall leiomyoma resection via different approaches. The minimally invasive partial cystectomy remains the most widely accepted technique; however, case reports for enucleation of bladder wall leiomyoma have also been described. The purpose of this video is to demonstrate the robotic extramucosal excision of a bladder wall leiomyoma, without cystotomy, but with complete removal of the muscular layer.

Materials and Methods:

A 35-year old male present with lower urinary tract symptoms and imaging showed bladder wall mass with histopathology showed leiomyoma. The patient consented for mass excision with the possibility of a partial cystectomy. The patient was placed in the supine, 30-degree Trendelenburg position during the procedure. A total of 4 ports were inserted. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. Extramucosal excision was accomplished without cystotomy and muscle approximation was achieved by 2 0 Vicryle.


The operative time was 90 minutes, blood loss of approximately 50mL and the patient was discharged after 72 hours with no immediate complications and a 6 months follow-up showed no recurrence.


Such a technique results in complete excision of the tumor, without cystotomy, and also maintains an intact mucosa. These steps, in addition to decreasing the risk of local recurrence, also shorten the period of postoperative catheterization and hospitalization.


Available at:

Submitted for publication: December 01, 2013

Accepted after revision: January 30, 2014

Received: December 01, 2013; Accepted: January 30, 2014

Correspondence address: Khalid Ebrahim Al-Othman, MD. Associate Professor uro-oncologist Medical and Clinical Affairs MBC 86. King Faisal Specialist Hospital & Research Center. P.O.BOX 3354, Riyadh 11211, Saudi Arabia. Fax: 009 661 442-4491. E-mail:

Editorial Comment

Al-Othman and colleagues from Riyadh Saudi Arabia present an elegant video demonstrating the robotic excision of a bladder leiomyoma. This is a rare, but good example of how the robot can be used to perform what in essence is a partial cystectomy. The visualization was perfect, the dissection meticulous and the reconstruction was beyond reproach.

A. Karim Kader, MD
Associate Professor
Department of Urology
University of San Diego
an Diego, CA, USA

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.