Department of Pediatric Urology, Jackson Memorial Hospital, Miami, 33136, FL, USA; Department of Urology, Miami University Medical School, Miami, 33136, FL, USA.
Department of Urology, Mount Sinai Medical Center of Florida, Miami Beach, 33140, FL, USA.
J Pediatr Urol. 2021 Aug;17(4):579-580. doi: 10.1016/j.jpurol.2021.05.002. Epub 2021 May 7.
We present a video case report of a pediatric patient with previous robotic abdominal surgery who underwent robotic assisted Monti-Yang continent ileovesicostomy. This 10-year-old female had a history of spina bifida, with previous myelomeningocele repair and ventriculoperitoneal shunt as an infant and robotic-assisted Malone procedure and artificial urethral sphincter placed 4 years ago. After undergoing bilateral hip surgery, she presented with difficult urethral catheterization due to reduced leg mobility. A Monti-Yang ileovesicostomy procedure was planned. A 5 mm laparoscopic port placed through the umbilicus followed by four additional DaVinci XI working ports. Twenty centimeters proximal the ileocecal valve, a 3 cm segment of ileum was dissected, then transected, detubularized, and retubularized around a 10 Fr catheter. This conduit was reimplanted to the anterior bladder wall. The other edge was fixed to the umbilicus. A 10 Fr Foley catheter was left clamped in the conduit, and a urethral Foley was left to gravity. Total operative time was 3 h 56 min. The patient did well post-operatively. She was discharged home on POD 6. Starting three weeks after surgery, the patient began catheterizing through the umbilical stoma. At 3 month follow-up, the patient catheterizes through her stoma every 3 h without leakage between catheterizations.
我们呈现了一个儿科患者的视频病例报告，该患者之前接受过机器人腹部手术，随后进行了机器人辅助 Monti-Yang 可控性回肠膀胱术。这位 10 岁的女性曾患有脊柱裂，在婴儿期接受过脊髓脊膜膨出修复和脑室腹腔分流术，4 年前接受过机器人辅助 Malone 手术和人工尿道括约肌植入术。在接受双侧髋关节手术后，由于腿部活动度降低，她出现了难以进行尿道导尿的情况。因此计划进行 Monti-Yang 回肠膀胱术。通过脐部放置一个 5 毫米的腹腔镜端口，然后再放置四个达芬奇 Xi 工作端口。在回盲瓣近端 20 厘米处，解剖出 3 厘米长的回肠段，然后进行横断、去管化，并围绕一个 10 Fr 导管进行再管化。该导管被重新植入前膀胱壁。另一端固定在脐部。一根 10 Fr Foley 导管夹闭在导管中，一根尿道 Foley 导管依靠重力引流。总手术时间为 3 小时 56 分钟。患者术后恢复良好。她在术后第 6 天出院回家。术后 3 周开始，患者开始通过脐部造口进行导尿。在术后 3 个月的随访中，患者每 3 小时通过造口进行导尿，导尿之间没有渗漏。
