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Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete
Mohan S Gundeti1, Michael K Eng, W Stuart Reynolds
1Section of Urology, University of Chicago Pritzker School of Medicine and Comer Children's Hospital, Chicago, Illinois 60637, USA.
Insights
This study details the first intracorporeal robotic-assisted augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric patient. The technique is feasible, offering good outcomes and cosmesis in selected cases.
Area of Science:
- Minimally Invasive Surgery
- Pediatric Urology
- Robotic Surgery
Background:
- Reports the first case of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric patient.
- Outlines the surgical technique and short-term results for this novel procedure.
Observation:
- The operative steps of the open procedure were replicated laparoscopically using robotic-assistance.
- A 20-cm ileal segment was isolated and anastomosed intracorporeally.
- The appendix was anastomosed to the bladder, and an ileal on-lay patch was created.
Findings:
- Robotic-assisted ileocystoplasty and appendicovesicostomy is feasible in pediatric patients.
- Early recovery, resumption of normal activities, and excellent cosmesis were observed.
- Preliminary results suggest a reasonable outcome in selected patients.
Implications:
- This technique may offer a minimally invasive option for bladder augmentation and continent diversion in pediatric urology.
- Further studies with larger case series are needed to compare robotic-assisted approaches with conventional open procedures.
- This approach could potentially improve patient recovery and cosmetic outcomes in select pediatric cases.
Introduction:
To the best of our knowledge, we report the first case of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric patient, outlining the surgical technique and short-term results.
Technical Considerations:
The operative steps of the open procedure were replicated laparoscopically using robotic-assistance. In brief, 5 transperitoneal laparoscopic ports were placed before docking the da Vinci S robotic system. A 20-cm ileal segment was isolated, and the gastrointestinal anastomosis was performed in an end-to-end fashion using intracorporeal suturing. The appendix was anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. The bladder was incised in a coronal plane, and the simple ileal on-lay patch was anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain were placed, and the Mitrofanoff stoma was then fashioned. Cystography was performed at 4 weeks postoperatively.
Conclusions:
This preliminary first successful report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in selected patients. However, whether a robotic-assisted approach provides any significant advantages over conventional open procedures is yet to be determined with a large case series.