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

Claire A Ostertag-Hill¹, Prathima Nandivada¹, Hatim Thaker²

¹Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, USA.

Pediatric Surgery International

|February 24, 2024

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Robotic-assisted appendicostomy offers a minimally invasive option for complex cases, including obese patients and those needing combined procedures. This technique demonstrates safe and effective outcomes, with over 90% of patients achieving consistent results with antegrade enemas.

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:

Keywords:

Antegrade continence enema Appendicostomy Appendicovesicostomy Neoappendicostomy Robotic-assisted surgery

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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.