Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective.

Area of Science:

• Minimally Invasive Surgery
• Robotic Surgery
• Pediatric Surgery

Background:

• Appendicostomy is a surgical procedure to create an opening for antegrade continence enemas.
• Traditional open appendicostomy can be challenging in patients with obesity or those requiring complex reconstructive surgery.
• Robotic-assisted surgery offers potential advantages in precision and visualization for minimally invasive procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of robotic-assisted laparoscopic appendicostomy and neoappendicostomy.
• To assess patient selection criteria, perioperative factors, and functional outcomes.
• To determine the feasibility of robotic approach in complex cases, including obese patients and those undergoing combined procedures.

Main Methods:

• Retrospective review of patients who underwent robotic-assisted appendicostomy or neoappendicostomy.
• Analysis of patient demographics, operative details, complications, and functional outcomes.
• Focus on cases involving obesity and combined colorectal and urologic reconstructive procedures.

Main Results:

• Twelve patients (8 appendicostomy, 4 neoappendicostomy) aged 8.8-25.8 years underwent the procedure.
• Five patients (41.7%) had a weight percentile >50%, and seven (58.3%) had combined procedures.
• 91.7% of patients achieved consistent results with antegrade enemas at a median follow-up of 10.8 months. Complications included surgical site infection, stricture, and granuloma.

Conclusions:

• Robotic-assisted appendicostomy and neoappendicostomy is a safe and effective minimally invasive approach.
• The robotic technique can overcome technical challenges in obese patients.
• It facilitates combined Malone and Mitrofanoff procedures in a single minimally invasive surgery.