The patient is placed in a steep trendlenburg position (Fig. 33.3). Special care should be taken to prevent pressure related injuries. The chest is strapped, the eyes are covered. In contrast to laparoscopic procedure the legs should be abducted and flexed in such a way that the robot can be docked in between the legs (Fig. 33.3). The port position is as shown in the figure (Fig. 33.2). The ports are placed in a fan shaped manner. The distance between the ports should be at least five fingers so as to avoid clashing in between the arms. Typically the telescope should be zero degree. The instruments used include a robotic shears, robotic large needle holder, robotic Maryland or robotic prograsp (Intuitive surgicals Inc, Sunnyvale US).

Once the robot is docked, the peritoneum with the urachal remnants are taken down with the bladder. The bladder is dropped down. A partially filled bladder helps in this part of the dissection. The probable area of the tumour is localized using cystoscopic localization or using the drop down ultrasound probe.

In the event that the tumor is near the ureteric orifice a preplaced ureteric catheter helps in preventing injury to the ureteric orifice. The tumor is excised using a electrocautery (Fig. 33.8) keeping a margin from the tumor. The suturing of the bladder defect is done using a 3-0 or 4-0 vicryl suture in a continuous fashion (Fig. 33.13). The robotic trocars do not require closure. All ports larger than 10 mm in size are closed. The specimen is examined after retrieving the specimen in a retrieval bag. A lymph node dissection is performed which includes the obturator, external and internal iliac templates. Drain is necessarily placed.

The indwelling catheter is placed in position for 5 days. The drain is removed once the drain output is less than 50 ml.