Robot-Assisted Laparoscopic Intracorporeal Hand-Sewn Bowel Anastomosis During Pediatric Bladder Reconstructive Surgery<sup />

Gundeti, Mohan S.; Wiltz, Aimee L.; Zagaja, Gregory P.; Shalhav, Arieh L.

doi:10.1089/end.2009.0463

Cited by 15 publications

(5 citation statements)

References 16 publications

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“…(iv) Does it have any advantages compared with its predecessor? We have previously shown that complete intracorporeal robotic‐assisted laparoscopic bowel anastomosis in children undergoing bladder reconstructive surgery is a feasible procedure [13]. This series builds on our previous experience, and applies it towards complete intracorporeal RALIMA.…”

Section: Discussionmentioning

confidence: 88%

Paediatric robotic‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? There is no information on robotic laparoscopic approach for reconstruction of the bladder and this is the first study to find out the feasibility and technique with this approach and see if there are any outcome differences. In the short term we have seen the advantages of early recuperation and less need of analgesic medication. OBJECTIVE To present the first series of complete intracorporeal robotic‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendico‐vesicostomy (RALIMA) in a paediatric population. PATIENTS AND METHODS From February to November 2008, six patients with neurogenic bladder secondary to spina bifida (status post corrective spine surgery) were selected to undergo RALIMA by a single surgeon (MSG) at the University of Chicago Medical Center. Patients had constipation, day and night‐time incontinence, with recurrent urinary tract infection (UTI), and failed attempts at anticholinergic therapy and clean intermittent catheterization. All had low‐capacity bladders with poor compliance and high leak point pressures. Preoperative bowel preparation was not performed. Mean follow‐up is 18 months. RESULTS One patient required conversion to open ileal augmentation because of failure to progress and another underwent augmentation ileocystoplasty without appendico‐vesicostomy. The average age of patients was 9.75 years (range 8–11 years). Average operative time was 8.4 h (range 6–11 h). There were no intraoperative complications. One patient had a postoperative wound infection, one had a lower extremity venous thrombus, and another had temporary unilateral lower extremity paresthesia that has resolved. Three patients required revision of their stoma at the skin‐level. Perioperatively, patients only required oral analgesia for 24–36 h (excluding one patient with paralytic ileus), started on liquid diet after 7.5 hours (range 6–10 h), on regular diet after 24 h (range 12–36 h) and were discharged home within 7 days. Postoperatively, patients demonstrated no leak on follow‐up cystogram, and were catheterizing per apendico‐vesicostomy (three patients by 6 weeks) or urethra (1 patient at 4 weeks). All patients now have day and night‐time continence with no UTIs, and bladder capacity of 250–450 mL. CONCLUSION While longer follow‐up will be necessary to see if these results are durable, this series demonstrates that RALIMA is a safe, feasible and effective procedure in the short term, with the possible added benefits of reduced analgesia, shorter recovery time and improved aesthetic appearance.

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Section: Discussionmentioning

confidence: 88%

Paediatric robotic‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique

et al. 2010

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“…Gundeti et al . in 2010 reported a successful series of completely intracorporeal reconstruction, showing also advantages in recuperation.…”

Section: Discussionmentioning

confidence: 99%

“…In that experimental cohort extracorporeal bowel anastomosis was pursued to avoid anastomotic leak. Gundeti et al [3] in 2010 reported a successful series of completely intracorporeal reconstruction, showing also advantages in recuperation.…”

Section: Discussionmentioning

confidence: 99%

“…After initial feasibility studies, this approach is now applied at few centres around the world to more complex procedures including bladder augmentation . Advancement of technique has led to complete intracorporeal reconstruction and anastomosis, rendering this approach ‘truly’ minimally invasive . However, adequately designed studies examining potential advantages and outcome differences of this new technique over the open approach are lacking.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…On the right side an inferior working port with a superior 12 mm assistant port for which a laparoscopic bowel stapler can be passed, however a robotic hand-sewn bowel anastomosis is also possible as described by Gundetti et al. [55] . Ileocystoplasty is usually performed with a concomitant catheterizable channel, and bilateral extravesical reimplantations with good postoperative results [56] .…”

Section: Surgeriesmentioning

confidence: 99%

Robotic surgery in pediatric urology

Howe

Kozel

Palmer

2017

Asian Journal of Urology

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While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.

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Robot-Assisted Laparoscopic Intracorporeal Hand-Sewn Bowel Anastomosis During Pediatric Bladder Reconstructive Surgery

Cited by 15 publications

References 16 publications

Paediatric robotic‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique

Paediatric robotic‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique

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

Robotic surgery in pediatric urology

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