Adamic Brittany, Kirkire Lakshmi, Andolfi Ciro, Labbate Craig, Aizen Joshua, Gundeti Mohan
Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA.
The University of Chicago Pritzker School of Medicine Chicago IL USA.
BJUI Compass. 2020 Mar 20;1(1):32-40. doi: 10.1002/bco2.7. eCollection 2020 Mar.
To describe the step-by-step techniques and modifications for robot-assisted augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric population with updated institutional results.
Robot-assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) protects the upper urinary tract and reestablishes continence in patients with refractory neurogenic bladder. Robotic assistance could provide the benefits of minimally invasive surgery without the challenges of pure laparoscopy. Here, we focus on the outcomes of RALIMA with salient tips and modifications of the technique.
We performed a retrospective review of our robotic database and identified 24 patients who underwent attempted robot-assisted laparoscopic augmentation ileocystoplasty (RALI) between 2008 and 2017 by a single surgeon at an academic center. Outcomes of interest included operative time, hospitalization time, postoperative complications, and change in bladder capacity. RALI and all concomitant procedures were performed using the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA, USA).
Of 24 patients, 20 successfully underwent RALI. Eighty percent underwent concomitant appendicovesicostomy (APV), 40% underwent antegrade continence enema channel formation (ACE), and 30% underwent a bladder neck procedure. Mean operative time was 573 minutes and the most recent RALIMA was 360 minutes. The average return to regular diet was 3.9 days and length of stay was 6.9 days. Mean change in bladder capacity was 244% postoperatively. Thirty-day complications were noted in 35% of patients; one Clavian grade I (5%) complication, five grade II (25%) complications, and one grade IIIb (5%) complication. With a median follow-up of 83.1 months we note a 25% incidence of bladder stones, 15% upper tract stones, 5% incidence of bladder rupture, and 5% small bowel obstruction. No patients required re-augmentation in the follow-up period.
RALI has similar functional outcomes and complications when compared with the open augmentation ileocystoplasty literature. RALI is desirable due to favorable pain control with decreased length of stay. Long-term outcomes after RALI are similar to the open approach. As the operative time is currently the largest point of criticism with the robotic approach, we discuss modifications to decrease the operative time.
描述机器人辅助扩大回肠膀胱成形术和米氏阑尾膀胱造瘘术在儿科患者中的分步技术及改进，并给出最新的机构研究结果。
机器人辅助腹腔镜扩大回肠膀胱成形术联合米氏阑尾膀胱造瘘术（RALIMA）可保护上尿路，并使难治性神经源性膀胱患者恢复控尿功能。机器人辅助可提供微创手术的优势，而无单纯腹腔镜手术的挑战。在此，我们重点关注RALIMA的手术效果以及该技术的显著技巧和改进。
我们对机器人手术数据库进行了回顾性分析，确定了2008年至2017年间在一家学术中心由一名外科医生尝试进行机器人辅助腹腔镜扩大回肠膀胱成形术（RALI）的24例患者。关注的结果包括手术时间、住院时间、术后并发症以及膀胱容量的变化。RALI及所有相关手术均使用达芬奇®手术系统（美国加利福尼亚州森尼韦尔市直观外科公司）进行。
24例患者中，20例成功接受了RALI。80%的患者同时进行了阑尾膀胱造瘘术（APV），40%的患者进行了顺行可控灌肠通道成形术（ACE），30%的患者进行了膀胱颈手术。平均手术时间为573分钟，最近一次RALIMA手术时间为360分钟。恢复正常饮食的平均时间为3.9天，住院时间为6.9天。术后膀胱容量平均变化为244%。35%的患者出现了30天内的并发症；1例Clavien I级（5%）并发症、5例II级（25%）并发症和1例IIIb级（5%）并发症。中位随访83.1个月时，我们发现膀胱结石发生率为25%，上尿路结石发生率为15%，膀胱破裂发生率为5%，小肠梗阻发生率为5%。随访期间无患者需要再次扩大手术。
与开放性扩大回肠膀胱成形术的文献相比，RALI具有相似的功能效果和并发症。由于疼痛控制良好且住院时间缩短，RALI是可取的。RALI术后的长期效果与开放手术方法相似。由于目前手术时间是机器人手术方法最受诟病的一点，我们讨论了减少手术时间的改进方法。
