## 4 Discussion  
As reported by the European Association of Urology (EAU) guidelines, RC with urinary diversion is the standard treatment recommended for non-metastatic MIBC while is an advised option for high-risk NMIBC [8]. Despite the variety of urinary diversions, orthotopic neobladder represents the preferred option by patients undergoing RC due to a better-preserved quality of life compared to other types of urinary continent and non-continent diversions, and due to the presence of an intracorporeal urine reservoir which avoids the need for a stoma and is more socially accepted by the patient [36]. Nevertheless, bladder reconstruction after RC represents one of the most challenging and technically demanding procedures in the urologic field, independent of the chosen technique. In this regard, most surgeons still perform the reconstruction of the urinary diversion in an extracorporeal manner, especially for neobladder reconstruction, due to the prolonged operative times and steep learning curve of an intracorporeal procedure [32]. Despite the challenge and the difficulty of a totally intracorporeal bladder reconstruction, the increasing experience in robotic pelvic surgery, the simplified suturing inherent to wristed instruments, the superior ergonomics, and the high-definition visualization, in addition to the possibility to limit the manipulation of the bowel (potentially avoiding the complications related to this issue), have greatly contributed to maintaining the totally intracorporeal bladder reconstruction as an appealing procedure [37]. Based on the literature, the ideal reservoir should have adequate capacity, low-pressure storage, absence of reflux, and high compliance to help continue while permitting voluntary emptying at convenient intervals, without residual urine. To obtain all these characteristics, the spherical reservoir has been evaluated as the best choice, due to the possibility to contain higher volumes at lower intraluminal pressures while contextually limiting the surface area and the potential issues related to the electrolyte exchange [19]. Nevertheless, a spherical reservoir with a large initial volume would not be associated with better continence rates and could instead be more prone to developing progressive enlargement, leading to atony and emptying failure [38]. The choice of orthotopic urinary neobladder shape and technique (among the many existents) is, however, based on surgeon preferences, experience and technical ease of performance, aiming to obtain the optimal reservoir. As previously reported, the creation of urinary diversion after robotic RC is considered the most challenging step of the entire surgical procedure. As result, in the majority of centers, the extracorporeal urinary diversion is the preferred choice due to the perceived difficulties with the intracorporeal bowel reconfiguration as well as the concerns regarding the time efficiency [39]. The objective pursued with our technique, i.e., the VON, was to obtain a reservoir which had all the previous characteristics while being easy and quickly reproducible for surgeons without an apical experience in intracorporeal bladder reconstruction. Compared to other techniques, our technique is easier and simpler and optimizes the final volume obtained with the same ileal loop length used, due to a complete detubularization [40]. Another interesting point of our technique is the absence of an antiperistaltic intestinal tract, as both ureters are anastomized in two completely detubularized horns [41]. A furtheradvantage of our technique is also related to the ipsilateral anastomosis of ureters, which are anastomized in two different positions (as for the Padua Ileal Bladder or the Y-shaped neobladder), as well as the lack of ureteral crossing or excessive manipulation to reach their definitive position. In this manner, the anatomical location is preserved and the neobladder is symmetrically allocated in the small pelvis, in a true orthotopic position, reducing the manipulation of the neobladder and the ureters to the minimum.