Analysis of Anastomotic Line Perfusion with Fluorescent Molecular Imaging After Augmentation Ileocystoplasty in Open and Robot-Assisted Laparoscopic Surgery

Abstract

Objective: An important complication of the augmentation ileocystoplasty is bladder perforation. Some authors have proposed that perforations result from ischemic necrosis in the bladder-bowel anastomotic sites. The aim of this study was to evaluate the tissue perfusion in the anastomotic suture line in augmentation ileocystoplasty performed with various techiques. Material and Methods: Four swines were used. The animals were divided into two groups, in pairs. In group 1, augmentation ileocystoplasty with U patch single-layer anstomosis (SLA) and U patch two-layer anastomosis (TLA) were performed by open surgery (OS). In group 2, the same procedures were performed with robot-assisted laparoscopic surgery (RALS). The perfusion of the bladder-ileum anastomotic line was evaluated by photodynamic eye. Results: The median width of the ischemic zone in SLA was 5 mm (range 2-14 mm) in OS, and 3 mm (range 2-14 mm) in RALS. The median width of the ischemic zone in TLA was 13 mm (range 10-19 mm) in OS, and 8 mm (range 4-12 mm) in RALS. Conclusion: In augmentation ileocystoplasty, intraoperative evaluation of the ischemic zone in the anastomotic line by photodynamic eye is an effective and feasible method. Single or two-layer anastomosis, perfomed either by OS or RALS seems to be not causing significant change in the ischemic zones. However, long-term results of similar studies should be determined to show the role of ischemia in the etiology of bladder perforations after augmentation ileocystoplasty.