Gundeti MS et al. (2008) Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal—initial case report. Urology 72: 1144–1147

In their recent paper, Gundeti et al. describe a completely intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy in a 10-year-old girl. The girl, who had a myelomeningocele closed at birth, had a small-capacity bladder with low detrusor leak-point pressure. She had grade I hydronephrosis and suffered from recurrent urinary tract infections and persistent incontinence.

The patient first underwent cystoscopy, with the stenting of both ureters, to aid intraoperative identification. A 12 mm trocar was placed through the umbilicus, and two 8 mm robotic ports were placed 7 cm lateral from the midline. Two additional ports were placed 7 cm lateral from the robotic ports for easy introduction of sutures into the abdomen. A 20 cm segment of ileum was isolated, and an end-to-end gastrointestinal anastomosis was created with intracorporeal suturing. The appendix was joined to the bladder wall over a feeding tube that had been placed through the appendix, after which anastomosis of the ileal segment to the bladder was performed. A suprapubic catheter and pelvic drain were inserted, and the Mitrofanoff stoma was created. The total operating time was 10 h. No preoperative bowel preparation was performed.

The patient was ambulatory on day 3 after surgery, and her urethral catheter was removed on day 5, after which she was discharged. She was completely continent at 6 weeks after surgery.

The laparoscopic technique results in shorter recovery time, lower analgesic requirement, and improved cosmetic outcome than the open procedure, say the authors. The long operating time would be expected to decrease considerably in subsequent procedures.