Abstract
Purpose: To report the current status of Robotic approach to creation of Catheterisable channel (CC) with the author's personal experience compared to published literature on technical steps, follow up, and outcomes.Methods: CC data was extracted from the prospective database set up for all Robotic pediatric urology procedures performed by the author at his institution. A literature search was then performed to look at the evidence base.Results: Eighteen consecutive cases (8M:7F) of Robotic approach to creation of CC was identified and included. All attempted cases were successfully completed without any conversion to open approach. Median age at surgery was 10.75 years (IQR 6.9–16.5); Median OT 197 min (IQR 131–295) with concomitant procedures in 4 cases. Appendix was used in 14 cases as CC conduit and distal ureter in 4 cases. Median Length of stay (LOS) was 2.75 days (IQR 2–6) and Median FU 27.3 m. Whilst FU duration is comparable to published series, average OT and LOS was much lower in this series. The LOS in this robotic series is much lower than the author's experience with open approach (2.75 vs. 5.8 days). No major complications postoperatively except for one exit site wound infection managed conservatively. None of the CC have been revised in this series and all channels are patent with 12 F or 14 F admissible catheter size. There were no cases of incontinence related to technique of creation of CC and no incidence of exit site stomal stenosis with use of ACE stopper until channel matures and Clean intermittent catheterisation (CIC) is established.Conclusion: Robotic approach to CC is feasible, safe with excellent outcomes and minimum morbidity. Robotic complex bladder reconstructive surgery offers some advantages to children compared to open approach but is only currently performed in few tertiary centers with expertise.
Highlights
Congenital and acquired affections to the bladder can lead to poor bladder emptying with attendant consequences of recurrent urinary tract infections, damage to renal upper tracts, and incontinence
Comparison of complications between open [28] cases; 54% EC in open cases and 3% in Robotic; Median FU 2.7 y; no significant difference in complication rates between open and robotic; 3 Clavien III complications in Robotic series
There are important points to highlight from the collective experience with common themes, variations in technique, and reported outcomes
Summary
Congenital and acquired affections to the bladder can lead to poor bladder emptying with attendant consequences of recurrent urinary tract infections, damage to renal upper tracts, and incontinence. Two vital landmark developments in the management of bladder emptying include Clean intermittent catheterization (CIC) per urethra introduced by Lapides in 1970s [1] and subsequent extension of this concept by Mitrofanoff to create catheterisable channel (CC) using appendix to facilitate bladder drainage when CIC per urethra is not feasible [2]. Open surgical approach was favored by most pediatric urologists with few reports of laparoscopic assisted attempt to create the channel. Robotics has recently provided an alternative with enhanced minimally invasive option in creating such channels with its attendant benefits [3, 4], not least to the surgeon due to ergonomics [5]. This article looks at the author’s personal experience with the Robotic approach, description of technical steps, and a review of published literature as regards potential benefits, current status and outcomes
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