Robotic‐Assisted Laparoscopic Ileocystoplasty and Continent Catheterizable Channels

Abstract

The use of robotic-assisted technology with the da Vinci Surgical System is well established in adult urology literature and its role is emerging in pediatric urology, especially for complex reconstructive surgeries. Children with neurogenic bladders secondary to spina bifida require reconstructive surgery, in the form of augmentation cystoplasty and catherizable channels (appendicovesicostomy and antegrade colonic enema) to achieve social urinary and fecal continence. Ambulatory children have a special challenge of pain management in their postoperative recovery, because the epidural analgesia is contraindicated and morphine causes paralytic ileus. The benefits of minimally invasive surgery may have immense value in this population. There have been isolated reports of continent catherizable channel formation, but complete intracorporeal cystoplasty was not performed because of the risk of bowel anastomosis leak in a porcine model. With our growing experience in minimally invasive surgery and porcine model work, we have studied the feasibility of this technique and have made the first successful report of the complete intracorporeal technique of ileocystoplasty with appendicovesicostomy (RALIMA), followed by initial case series experience.