Does robot‐assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery?

Abstract

Objectives• To compare perioperative outcomes between open ileocystoplasty and robot-assisted laparoscopic ileocystoplasty (RALI) in a porcine model, as objective data comparing outcomes between these two approaches in children with neurogenic bladder are lacking.• We specifically examined differences in postoperative peritoneal adhesion formation between the groups. Materials and Methods• In all, 20 pigs were assigned to an open ileocystoplasty or RALI study arm. All the pigs underwent an initial urodynamic study (UDS). • In the RALI arm, reconstructive steps were performed intracorporeally using a standard da Vinci ® system. Postoperatively, variables including first stool, weight gain, and complications were recorded.• After 42 days, the pigs underwent a final UDS followed by adhesion assessment.• Intraperitoneal adhesions were quantified by a third-party 'blinded' surgeon according to previously described objective scoring systems. Results• Preoperative variables including UDS were similar in both groups.• Overall operating time was significantly shorter for open ileocystoplasty than for RALI (149 vs 287 min, P < 0.001, respectively). Postoperatively, all variables including time to first stool, weight gain, and urodynamic parameters were similar amongst the groups.• Pigs in the open arm developed significantly more adhesions (P = 0.02) and adhesions with a higher complexity (P = 0.04). Conclusions• In this porcine model, RALI achieved similar functional outcomes as the open approach, but required longer procedural times.• The number and complexity of surgical adhesions among the groups favoured the RALI cohort. This may be of clinical significance in the paediatric spina bifida population, who generally undergo multiple surgical procedures in their lifetime, with increased risk for development of adhesions and subsequent intestinal obstruction.

Expanding the indications of robotic surgery in urology: A systematic review of the literature

“…Following the first case report of RAI by Gundeti et al [95] in 2008, 64 cases have subsequently been reported in the literature in 13 publications. Seven of these were single case reports and of the remaining six articles, five were published from the same group encompassing similar time periods [96] , [97] , [98] , [99] , [100] , [101] .…”

Surgery strategy of 13 cases to control bleeding from the liver on laparoscopic repeat liver resection for recurrent hepatocellular carcinoma

“…Laparoscopic surgery, however, can significantly reduce adhesions and therefore make repeated resections more viable. [1718] LRLR has been widely used in the treatment of HCC due to the advantages of being minimally invasive, but LRLR is still not the typical procedure used for rHCC. If it can be proved that LRLR has similar validity and safety as ORLR, then it may become more widely used.…”

Pediatric robotic urologic surgery-2014

“…For example, we have shown in a porcine model that there are decreased numbers and complexity of adhesions with robotic ileocystoplasty over a conventional open approach. [30] Given that many spina bifida patients require multiple abdominal surgeries over the course of their lives, decreased adhesions may result in decreased complications in the long run. There may be many more benefits that have yet to be quantified or manifested given the relatively short time course of robotic surgery to date.…”