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Robotic approach to pediatric augmentation cystoplasty: Feasibility, long-term outcomes, and technical refinements
Priyank Yadav1, Deepak K Kandpal2, Sujit K Chowdhary2
1Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Robotic augmentation cystoplasty in children significantly improves bladder capacity and reduces pressure, offering a safe and effective alternative to open surgery. This minimally invasive approach leads to durable, positive long-term functional outcomes and preserves renal health.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Pediatric bladder dysfunction can lead to serious kidney problems if not managed.
- Open augmentation cystoplasty is the traditional surgical treatment.
- Robotic-assisted surgery presents a less invasive option.
Purpose of the Study:
- To assess the institutional experience with robotic augmentation cystoplasty in pediatric patients.
- To analyze technical modifications, surgical outcomes, and long-term results.
- To evaluate the safety and efficacy of this robotic approach.
Main Methods:
- Prospective study of 11 children undergoing robotic augmentation cystoplasty.
- Standardized technique using ileal U-pouch and bladder bivalving with da Vinci system.
- Included urodynamic studies, assessment of complications, and renal function monitoring.
Main Results:
- All surgeries completed robotically; mean operative time 355.5 min, blood loss 294.5 ml.
- Significant increase in bladder capacity (383%) and decrease in detrusor pressure (62.1%).
- No major complications; improved continence and stable upper tract outcomes over 74 months mean follow-up.
Conclusions:
- Robotic augmentation cystoplasty is a safe and effective alternative for pediatric patients.
- Demonstrates significant and durable functional improvements.
- Selective Mitrofanoff creation may reduce morbidity while maintaining success.
Introduction:
Pediatric bladder dysfunction refractory to conservative management poses significant risks to renal function. While open augmentation cystoplasty is the standard for surgical intervention, robotic-assisted techniques offer a minimally invasive alternative. This study evaluates our institutional experience with robotic augmentation cystoplasty in children, focusing on technical modifications, perioperative outcomes, and long-term functional results.
Patients And Methods:
This prospective series included 11 children who underwent robotic augmentation cystoplasty between January 2014 and December 2023. All had small-capacity, high-pressure bladders unresponsive to anticholinergics, clean intermittent catheterization, and/or intravesical botulinum toxin injection. Preoperative workup included ultrasonography, dimercaptosuccinic acid scans, and videourodynamic studies. A standardized technique using a detubularized ileal U-pouch and bladder bivalving was performed using the da Vinci Si/Xi system. Concomitant procedures included ureteric reimplantation and Mitrofanoff appendicovesicostomy in select cases. Outcomes assessed included operative parameters, urodynamic changes, complication rates, and long-term renal function.
Results:
All surgeries were completed robotically without conversion. The mean age at surgery was 8.4 years (range: 2-15 years). Mean operative time was 355.5 min and mean estimated blood loss was 294.5 ml. Concomitant ureteric reimplantation was performed in 6 patients and Mitrofanoff creation in 1 patient. Mean bladder capacity improved from 86.4 ml to 283.6 ml (mean increase 383 %), and mean detrusor pressure decreased from 57.5 cm H2O to 21.8 cm H2O (62.1 % reduction). There were no major complications. Over a mean follow-up of 74 months, all patients reported improved continence and stable upper tract outcomes.
Conclusion:
Robotic augmentation cystoplasty is a safe, effective, and durable alternative to open surgery in well-selected pediatric patients. Long-term outcomes demonstrate significant functional improvement. Our selective approach to Mitrofanoff creation may minimize morbidity while preserving surgical success.
