A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy

Gundeti, Mohan S.; Petravick, Michael E.; Pariser, Joseph J.; Pearce, Shane M.; Anderson, Blake; Grimsby, Gwen M.; Akhavan, Ardavan; Dangle, Pankaj P.; Shukla, Aseem R.; Lendvay, Thomas S.; Cannon, Glenn M.; Gargollo, Patricio C.

doi:10.1016/j.jpurol.2016.05.031

Cited by 49 publications

(30 citation statements)

References 20 publications

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“…Gundeti et al . reported a multi‐institutional study of robotic‐assisted laparoscopic Mitrofanoff APV surgical outcomes, and continence rates were comparable to previous open series with low complication rates .…”

Section: Distinctive Robotic Surgeries For Pediatric Patientssupporting

confidence: 63%

“…With regard to APV, the foundation for success of the Mitrofanoff principle is based on creating a submucosal tunnel. Gundeti et al reported a multiinstitutional study of robotic-assisted laparoscopic Mitrofanoff APV surgical outcomes, and continence rates were comparable to previous open series with low complication rates (73).…”

Section: Other Reconstructive Robotic Surgeries In Pediatric Patientsmentioning

confidence: 56%

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Robotic surgery in pediatric urology: Current status

Mizuno

Kojima

Nishio

et al. 2018

Asian J Endoscop Surgery

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Robot‐assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3‐D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

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Section: Distinctive Robotic Surgeries For Pediatric Patientssupporting

confidence: 63%

Section: Other Reconstructive Robotic Surgeries In Pediatric Patientsmentioning

confidence: 56%

Robotic surgery in pediatric urology: Current status

Mizuno

Kojima

Nishio

et al. 2018

Asian J Endoscop Surgery

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“…Contemporary open augmentation enteroscystoplasty times are not readily available in the literature. However, one group noted an average of 234 minutes for extraperitoneal approach and 336 minutes for intraperitoneal approach . Analysis of the NSQIP data by McNamara et al revealed a median operative time of 426 minutes for augmentation ileocystopasty with appendicovesicostomy, 318 minutes for an augmentation alone, and 234 minutes for appendicovesicostomy only .…”

Section: Discussionmentioning

confidence: 99%

“…Augmentation ileocystoplasty leads to decreased voiding pressures as well as increased bladder capacity and continence. The majority of patients undergoing this procedure have neurogenic bladder or valve bladder due to posterior urethral valves . Additional abnormalities that account for the condition include the spectrum of spina bifida …”

Section: Introductionmentioning

confidence: 99%

“…In the majority of cases, augmentation ileocystoplasty is coupled with the creation of a continent catheterizable channel (CCC) which allows for patients to achieve social continence and to avoid urethral catheterization. Urethral catheterization can ultimately cause discomfort in a sensitive urethra as well as complications such as trauma, strictures, and eventually patient noncompliance . Most often, the appendix is used for the CCC (Mitrofanoff appendicovescostomy) but another common technique is using a transversely tubularized segment of bowel as a channel (Yang‐Monti technique).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Robot‐assisted laparoscopic continent cutaneous urinary diversion in adults: A single‐centre study

Loubersac,

Lavallée,

Reiss

et al. 2024

BJUI Compass

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ObjectivesTo show that robot‐assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.Materials and methodsWe conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre‐ and postoperative urodynamic evaluations.Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.ResultsTwelve patients, mostly women (n = 11), median (IQR) age 47.4 (19–57) years underwent RALCCUD (four Mitrofanoff, four Yang‐Monti and four Casale). The main indication for surgery was inability to perform intermittent self‐catheterization through the native urethra.Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.Median (IQR) operative time was 313 (285–367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow‐up was 51 (40–61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.At the last follow‐up, all patients could self‐catheterize through the tube, and the stomal and urethral continence rate was 100%.ConclusionRALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.

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A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy

Cited by 49 publications

References 20 publications

Robotic surgery in pediatric urology: Current status

Robotic surgery in pediatric urology: Current status

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

Robot‐assisted laparoscopic continent cutaneous urinary diversion in adults: A single‐centre study

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