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Robotic-assisted laparoscopic MACE.

Rebecca S Zee1, Nora G Kern1, C D A Herndon2

  • 1Department of Urology, University of Virginia, Charlottesville, VA, USA.

Journal of Pediatric Urology
|July 25, 2017
PubMed
Summary
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A new robotic-assisted technique creates a Malone antegrade continence enema (MACE) channel, improving fecal continence and cosmetic outcomes for patients with neurologic conditions.

Area of Science:

  • Minimally invasive surgery
  • Pediatric surgery
  • Urology

Background:

  • Malone antegrade continence enema (MACE) is used for fecal incontinence and constipation in neurologic conditions.
  • Traditional MACE creation involves open or laparoscopic surgery.
  • Open surgery allows cecal imbrication for better continence, while laparoscopy typically does not.

Observation:

  • A novel technique utilizes robotic assistance and laparoscopy to create a MACE channel.
  • This method involves placing robotic and laparoscopic ports strategically.
  • Mesenteric fenestrations enable cecal imbrication around the appendix, forming the continence channel.

Findings:

  • The described technique successfully creates a MACE channel using robotic and laparoscopic approaches.
Keywords:
Minimally invasive surgeryNeurogenic bowelReconstructionRobotic-assisted surgery

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  • It allows for imbrication of the cecum around the channel, a feature often limited in purely laparoscopic MACE.
  • The procedure was performed without the need for an open incision.

    • Implications:

    • This robotic-assisted MACE technique offers a minimally invasive option for improving continence.
    • It potentially enhances cosmetic results by avoiding a large midline incision.
    • This approach may reduce the risk of perforation associated with MACE creation.