Completely intracorporeal robotic-assisted laparoscopic ileovesicostomy: initial results.

Maryellen T Dolat,B Mayer Grob,Blake W Moore,Lance J Hampton,Adam P Klausner

doi:10.1007/s11701-013-0443-y

Abstract

We present a series of robotic-assisted laparoscopic ileovesicostomies with bowel work performed completely intracorporeally. The four patients selected for this procedure were all diagnosed with neurogenic bladder and failed conservative medical therapy. Preoperative patient data included age, body mass index (BMI), and urodynamic (UD) study results. Intra-operative data included estimated blood loss (EBL), operative time, and intra-operative complications. Post-operative data included return to bowel function, post-operative complications, and length of hospital stay (LOS). All bowel work was completed intracorporeally with the exception of stoma maturation. Four robotic ileovesicostomies were performed. Pre-operative urodynamic study results showed either elevated detrusor pressures or limited bladder capacities in addition to the inability to perform self-catheterization. The mean patient age was 40 years and mean BMI was 26 kg/m2. Average EBL and operative time were 131 ml and 290 min, respectively. No intra-operative complications occurred. Bowel function, as defined as flatus, returned on average 3.8 days after surgery and average LOS, defined as discharge home or discharge to the spinal cord unit, was 7.5 days. Mean follow-up time was 25.8 months. Post-operative urodynamic studies revealed low stomal leak point pressure (<10 cmH2O). This study is the first to describe a completely intracorporeally robotic-assisted laparoscopic ileovesicostomy with safe and effective outcomes after more than 2 years of follow-up.

Highlights

We present a series of robotic-assisted laparoscopic ileovesicostomies with bowel work performed completely intracorporeally
The four patients selected for this procedure were all diagnosed with neurogenic bladder and failed conservative medical therapy
Ileovesicostomy has been performed using an open technique that is associated with post-operative complications including wound infection, urethral incontinence, and extended length of hospital stay (LOS) [7]

Summary

Materials and methods

Pre-operative patient data included age, body mass index (BMI), and urodynamic (UD) study results. Preoperative data No of patients Mean age (years) Mean BMI (kg/m2) Intra-operative data EBL (ml) Total operative time (min) Conversion to open Postoperative data Length of hospital stay (days) Return of bowel function (days) No of major complications Mean follow-up time (months). Three of the four patients had post-operative urodynamic studies revealing an average stomal leak point pressure of 5.3 cmH2O (SD 4.5, range 1–10 cmH2O) and average volume at which leakage occurred of 141.3 ml (SD 138.3, range 46–300 ml). Counseled that a low pressure system provided a functionally acceptable result, the patient remained concerned about potential infection from an elevated residual volume and an open conversion of ileovesicostomy to ileal conduit was performed approximately 16 months after his initial surgery

Results

Conclusion