Pediatric laparoscopic ileal cystoplasty: complete intracorporeal surgical technique

Despite the widespread introduction of laparoscopy in pediatric urology, many reconstructive procedures, such as augmentation cystoplasty, are still performed in an open fashion because of the perceived intricacy and demanding nature. Because we continue to introduce advanced laparoscopic skills into the care of children, we describe our technique for complete intracorporeal laparoscopic enterocystoplasty in a pediatric patient.

The key elements of the procedure include a thorough preoperative mechanical bowel preparation; cystoscopic evaluation and placement of externalized ureteral stents; transperitoneal placement of three radially dilating trocars (one large enough to allow advancement of a laparoscopic stapler); the selection and measurement of a 20-cm ileum segment with sufficient mobility; the development of the perivesical space and lateral attachments, followed by a generous cystotomy; isolation of the bowel segment and side-to-side anastomosis using endoscopic staplers; intracorporeal irrigation of the segment followed by antimesenteric detubularization; temporary stabilization of the bowel segments using percutaneous traction sutures, allowing the avoidance of extra trocars in children with limited intraabdominal space; intracorporeal suturing of the detubularized bowel into a U-shaped configuration; fixation of the ileal patch to the bladder, followed by watertight anastomosis with running sutures; irrigation and placement of a closed suction drain in the pelvis; and cystography 4 to 6 weeks postoperatively.

Pure laparoscopic enterocystoplasty in children is an advanced procedure that is technically demanding. Although it appears feasible and provides a minimally invasive option to bladder augmentation, its equivalency or superiority over laparoscopic assisted or conventional open techniques remains to be demonstrated.