Bladder diverticulum is a condition characterized by herniation of the bladder mucosa through a defect between the detrusor muscle fibers. Common causes include bladder outlet obstruction, particularly due to benign prostatic hyperplasia, as well as neurogenic bladder, chronic urinary tract infections, or congenital anomalies. Surgical indications for diverticulectomy include failure of medical management, persistent symptoms despite relief of obstruction, or the presence of malignancy within the diverticulum. The choice of surgical approach and intraoperative techniques depends largely on the number, size, and location of the diverticulum, as well as any associated anatomical or pathological conditions. While current consensus supports robotic-assisted laparoscopic diverticulectomy due to its lower complication rates and faster recovery times, no universally accepted standardized technique exists. This study aims to demonstrate the role of minimally invasive diverticulectomy across varied clinical contexts, emphasizing the tailored surgical techniques applied in each case.

Three patients with distinct clinical presentations underwent robotic bladder diverticulectomy. Intraoperative videos were edited to highlight key technical steps. Patient confidentiality was strictly maintained, and informed consent was obtained. Additionally, a summary of follow-up data from all cases performed at our institute using different surgical approaches has been compiled and analyzed.

Each case demonstrated the importance of adapting surgical techniques to individual anatomical and clinical scenarios. The robotic approach was favored for its enhanced precision, superior visualization, reduced blood loss, shorter hospitalization, and expedited recovery. However, surgical success was also closely linked to the operating surgeon's expertise and their ability to customize the procedure based on diverticular anatomy.

Minimally invasive bladder diverticulectomy offers a safe, effective alternative to traditional open surgery, with comparable or superior perioperative outcomes. The choice of technique should be guided by the indication for surgery and individual patient anatomy, underscoring the need for a flexible, case-specific approach.