Robot‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: Step‐by‐step and modifications to UChicago technique

Abstract

Objective To describe the step‐by‐step techniques and modifications for robot‐assisted augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric population with updated institutional results. Introduction Robot‐assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) protects the upper urinary tract and reestablishes continence in patients with refractory neurogenic bladder. Robotic assistance could provide the benefits of minimally invasive surgery without the challenges of pure laparoscopy. Here, we focus on the outcomes of RALIMA with salient tips and modifications of the technique. Methods We performed a retrospective review of our robotic database and identified 24 patients who underwent attempted robot‐assisted laparoscopic augmentation ileocystoplasty (RALI) between 2008 and 2017 by a single surgeon at an academic center. Outcomes of interest included operative time, hospitalization time, postoperative complications, and change in bladder capacity. RALI and all concomitant procedures were performed using the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Results Of 24 patients, 20 successfully underwent RALI. Eighty percent underwent concomitant appendicovesicostomy (APV), 40% underwent antegrade continence enema channel formation (ACE), and 30% underwent a bladder neck procedure. Mean operative time was 573 minutes and the most recent RALIMA was 360 minutes. The average return to regular diet was 3.9 days and length of stay was 6.9 days. Mean change in bladder capacity was 244% postoperatively. Thirty‐day complications were noted in 35% of patients; one Clavian grade I (5%) complication, five grade II (25%) complications, and one grade IIIb (5%) complication. With a median follow‐up of 83.1 months we note a 25% incidence of bladder stones, 15% upper tract stones, 5% incidence of bladder rupture, and 5% small bowel obstruction. No patients required re‐augmentation in the follow‐up period. Conclusions RALI has similar functional outcomes and complications when compared with the open augmentation ileocystoplasty literature. RALI is desirable due to favorable pain control with decreased length of stay. Long‐term outcomes after RALI are similar to the open approach. As the operative time is currently the largest point of criticism with the robotic approach, we discuss modifications to decrease the operative time.

Narrative review: robotic pediatric surgery—current status and future perspectives

“…Only one article was included in our review of the last 5 years ( 40 ), describing the experience of the American Center with RALMA technique, over a cohort of 24 patients, demonstrating a decreased post-operative pain with reduced post-operative opioid drugs, a better cosmesis, presenting a safe and feasible technique with comparable complication rates (35% of 30 day complication rate), functional and long-term outcome to the OP, with just increased operative time which can be decreased with the experience of the surgical equipe.…”

Robotic-assisted surgery in the pediatric surgeons’ world: Current situation and future prospectives

“…A more recent report by Adamic et al included 24 patients who underwent RAI, of which 20 patients were successfully performed using da Vinci. A series of concomitant procedures were performed, including 16 APV, 8 antegrade continence enema (ACE), and 6 bladder neck reconstruction procedures ( 35 ). These results showed that the robot offers not only the intrinsic advantages of MIS but also comparable functional outcomes to open or laparoscopic procedures.…”

Uso de la técnica Mitrofanoff en pacientes pediátricos con vejiga neurógena

“…La técnica quirúrgica de Mitrofanoff proporciona una desviación urinaria contenida que se basa en una alternativa a través del drenaje de la vejiga por medio de una apendicovesicostomía, en el cual se realiza por medio del apéndice formando un pequeño tubo o de intestino. Cuando el procedimiento realizado con el intestino es llamado Monti o ileovesicostomía (Adamic et al, 2020).…”

“…Las complicaciones potenciales de esta técnica implican la fuga urinaria debido a través del nuevo estroma, así como la uretra porque el paciente no está cumpliendo de manera rigurosa el programa de cateterismo (Adamic et al, 2020). La estenosis del estroma, donde existe la posibilidad que la introducción del catéter produzca dolor y la inserción sea difícil (Forster et al, 2020).…”