Laparoscopy-Assisted Catheterizable Continent Urinary Conduits

Abstract

Purpose: A laparoscopy-assisted approach to the creation of catheterizable continent urinary conduits provides enhanced surgical exposure and allows complex reconstruction to be performed through small and cosmetically appealing incisions. Patients and Methods: Clinical experience with six myelodysplastic children (five boys, one girl; mean age 11.3 years) undergoing laparoscopy-assisted appendicovesicostomy and ileal augmentation cystoplasty over a 7-month interval is compared with published reports. One 10-mm umbilical camera port and two 5-mm working ports were used in four children. In the two others, a hand-assisted laparoscopic approach using the Dexterity® Pneumo Sleeve™ set was used. Results: All six children underwent successful creation of an appendicovesicostomy with an umbilical stoma after extensive laparoscopic mobilization of the ascending colon. Thereafter, ileal bladder augmentation was performed in all six through a Pfannenstiel incision. A bladder neck wrap procedure was also completed in three of the boys. Laparoscopic dissection times ranged from 30 to 80 minutes. Postoperative pain control and length of hospitalization (mean 5 days) were improved in comparison with a standard approach using an extended lower midline abdominal incision. Conclusions: Laparoscopy-assisted mobilization of the right colon and appendiceal mesentery promotes optimal placement of the appendicovesicostomy stoma within the umbilicus and allows the remainder of planned urinary tract reconstruction to be completed through a Pfannenstiel incision. Cosmetic appearance is enhanced, and perioperative morbidity is minimized.