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Robotic appendicovesicostomy revision in children: description of technique and initial results
Paul H Chung1, Shuvro De, Patricio C Gargollo
11 Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center , Dallas, Texas.
Insights
Robot-assisted appendicovesicostomy (APV) revision is a safe and effective procedure for children experiencing APV leakage. This minimally invasive technique successfully resolved leakage in all initial patients.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Appendicovesicostomy (APV) is a surgical procedure to create a channel for bladder drainage.
- Complications such as leakage can occur, necessitating revision surgery.
- Robotic assistance offers potential advantages in complex pediatric reconstructive surgery.
Observation:
- Three pediatric patients with bladder dysfunction underwent robot-assisted APV revision due to persistent leakage after initial surgery.
- Indications included posterior urethral valves, myelomeningocele, and spinal cord transection.
- Leakage persisted despite conservative management.
Findings:
- Robot-assisted APV revision was technically feasible with minimal blood loss (≤5 mL) and acceptable operative times.
- Intraoperative findings revealed partial to complete separation of the APV from the bladder tunnel.
- All patients achieved complete resolution of APV leakage post-revision.
Implications:
- This study demonstrates the feasibility and safety of robot-assisted APV revision in pediatric patients.
- Expanding the application of robotic surgery in pediatric urology.
- Offers a viable solution for managing challenging APV complications.
Purpose:
To report our initial results of robotic appendicovesicostomy (APV) revision in children.
Patients And Methods:
Three patients (median age 6 years; range 6-13) underwent robot-assisted APV surgery for bladder dysfunction because of posterior urethral valves, myelomeningocele, and traumatic spinal cord transection. Leakage developed in each patient from the APV. After failing more conservative treatments, the patients subsequently underwent robot-assisted APV revision.
Results:
Robot-assisted APV revision was conducted at a median 14 months (range 6-34 mos) after initial surgery. Median operative time was 165 minutes (range 106-232 min), and blood loss was ≤5 mL for all patients. Intraoperative findings ranged from partial to complete separation of the APV from the bladder tunnel. APV leakage resolved for all patients at last follow-up (median 5 months; range 2-9 mos).
Conclusion:
This initial series expands the scope of robotic surgical procedures in children. Robot-assisted APV revision was technically feasible and safe in this early experience.
