Spiral Monti catheterisable continent channel performed by robot-assisted approach

A catheterisable continent channel (CCC) is indicated in the treatment of neurogenic bladder. The most performed CCC is the Mitrofanoff's appendicovesicostomy. In case of unavailable cecal appendix, a Monti's ileovesicostomy, consisting in a tubularised ileal conduit, could be performed. This intervention benefits from the ergonomic advantages of robot-assisted laparoscopy.

We describe a case of a 25-year woman affected by neurogenic bladder consequent to a spina bifida.

A previous Mitrofanoff CCC failed due to ischemia of the conduit. The bladder voiding was managed by urethral self-catheterization and button cystostomy for several years. A spiral Monti CCC was planned. The intervention was performed by robot-assisted laparoscopic approach. Four robotic 8-mm robotic trocars and one 5-mm trocar were inserted in the umbilic, in both flanks and left hypochondrium respectively. A bowel segment was isolated and spirally shaped to obtain a sufficient length for the CCC.

The length of surgery was 360 min, including docking time. The patient was discharged after two days. At 9-month follow-up, the channel is continent and catheterisable by a 16 Fr tube. No further episodes of UTIs or other complications were reported.

A complete intracorporeal approach was achieved thanks to the robotic platform.