Robot-assisted Laparoscopic Augmentation Ileocystoplasty and Mitrofanoff Appendicovesicostomy in Children: Updated Interim Results

Abstract

Background: Robot-assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) may protect the upper urinary tract and reestablish continence in patients with refractory neurogenic bladder. Robotic assistance can provide the benefits of minimally invasive surgery without the steep learning curve of pure laparoscopy.

Objective: To highlight the interim outcomes of RALIMA with salient tips and technical modifications through comparison with patients undergoing open augmentation ileocystoplasty (OAI).

Design, settings, and participants: A retrospective chart review of 17 patients undergoing robot-assisted laparoscopic augmentation ileocystoplasty (RALI) and 13 patients undergoing OAI by a single surgeon at an academic center from 2008 to 2012 (OAI) or 2014 (RALI).

Surgical procedure: RALI and all concomitant procedures were performed completely intracorporeally using the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA).

Outcome measurements and statistical analysis: Outcomes of interest included change in bladder capacity, operative time, pain medication use, hospitalization time, and perioperative complication rates.

Results and limitations: Of 17 patients selected, 15 successfully underwent RALI. Overall, 11, 6, and 4 patients had a concomitant Mitrofanoff appendicovesicostomy, antegrade colonic enema channel, and bladder neck closure, respectively. The median operative time was significantly longer in RALI (623 vs 287 min; p<0.01). Median length of stay (LOS) was shorter in RALI (6 vs 8 d; p=0.01). The postoperative percentage increase in bladder capacity, narcotic use, and complication rates did not differ between RALI and OAI. Limitations include the retrospective study design and the small cohort of patients.

Conclusions: RALI appears to offer functional outcomes similar to OAI. Although it is a significantly longer procedure, it may decrease LOS and avoid epidural use. Further refinements may reduce operative time.

Patient summary: In this report, we examined outcomes after robotic bladder augmentation surgery in children. We found that the robotic approach may eliminate epidural analgesia use and decrease hospitalization time after surgery.

Keywords: Appendicovesicostomy; Augmentation ileocystoplasty; Lower urinary tract; Neurogenic bladder; Pediatric urology; Robotic surgery; Upper urinary tract.