Pediatric Robotic-assisted Laparoscopic Augmentation Ileocystoplasty And Mitrofanoff Appendicovesicostomy: Complete Intracorporeal - Initial Case

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 01 Dec 2008 - 0:00 PST

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UroToday.com - In this article, Dr. Mohan S. Gundeti, et al., from the University of Chicago reported on an initial experience with a pediatric robotic assisted laparoscopic augmentation in the execution of a Mitrofanoff appendicovesicostomy. They utilized five transperitoneal laparoscopic ports before docking the daVinci S robotic system. Their mobilization was done laparoscopically before using robotic assistance. They isolated a 20 cm ileal segment, and performed an end-to-end fashion gastrointestinal anastomosis using a completely intracorporeal method. They placed an 8 French feeding tube through the appendix and anastomosed it to the right posterior wall of the bladder in an extravesical fashion. They then incised the coronal plane and laid a simple onlay patch to the posterior and anterior wall of the bladder. They also placed a suprapubic catheter and pelvic drain. The Mitrofanoff stoma was created in the standard v-flap fashion. They performed cystography at four weeks postoperatively to show an excellent bladder contour and no leak.

This group showed that the envelope can be pushed with robotic surgery secondary to the excellent ergonomics that would otherwise make this procedure laparoscopically daunting. I have personally performed both laparoscopic and robotic augmentation and feel that a totally intracorporeal bladder augmentation is more easily facilitated with robotic assistance than it is with pure laparoscopy.

I must caution that this procedure is still in its infancy, and it is technically very demanding. This study also stated that it is unclear whether a robotic assisted approach provides any significant advantage over conventional open procedures. In my limited experience I found that bowel function returns earlier and most of these patients are discharged home on postoperative day #2, tolerating a regular diet. Nonetheless my experience is extremely limited with only three patients in total. Here at our institution we have become very conservative with bladder augmentation and try to put it off as much as we can utilizing maximized medical therapy as well as overnight catheter drainage to help protect the upper tracts.

Gundeti MS, Eng MK, Reynolds WS, Zagaja GP
Urology. 2008 Nov;72(5):1144-7.
doi:10.1016/j.urology.2008.06.070

Written by UroToday.com Medical Editor Pasquale Casale, MD

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