V03-02 TOTALLY ROBOTIC INTRACORPOREAL YANG-MONTI CONTINENT ILEOVESICOSTOMY IN PATIENT WITH PREVIOUS ROBOTIC SURGERY - TECHNIQUE DESCRIPTION

Abstract

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-02 TOTALLY ROBOTIC INTRACORPOREAL YANG-MONTI CONTINENT ILEOVESICOSTOMY IN PATIENT WITH PREVIOUS ROBOTIC SURGERY - TECHNIQUE DESCRIPTION Cinthia Galvez, Diana M. Lopategui, Laura Horodyski, and Miguel Castellan Cinthia GalvezCinthia Galvez More articles by this author , Diana M. LopateguiDiana M. Lopategui More articles by this author , Laura HorodyskiLaura Horodyski More articles by this author , and Miguel CastellanMiguel Castellan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last 4 decades, since the description of the appendix continent vesicostomy by Mitrofanoff, many variations have been described, including the Yang and Monti procedures in 1993 and 1997 respectively. The introduction of minimally invasive technologies challenged the pediatric urologists to develop these techniques and transition from open to robotic assisted. We present a video case report of a pediatric patient who underwent robotic assisted Monti-Yang continent ileovesicostomy. METHODS: Patient is a 10-year-old female patient with a history of neurogenic urinary incontinence due to spina bifida. She had a past surgical history of several surgical procedures including myelomeningocele repair at birth, ventriculoperitoneal (VP) shunt at 3-month-old, robotic assisted Malone procedure and robotic assisted artificial urethral sphinter (AUS 800) placed 4 years ago. She used to void and do clean intermittent catheterization (CIC) per urethra but, after her bilateral hip surgery, she had significant difficulty for catheterization due to reduced leg mobility. Decision was made to perform an intracorporeal Monti-Yang ileovesicostomy procedure to allow her to avoid urethral catheterization. For the procedure, a “V”-shape flap incision was made at the umbilicus and under an open Hasson technique a 5-mm assistant laparoscopic port was introduce. A 12 mm robotic port at the superior right quadrant. Additional three robotic working arm 8-mm were placed: at midline 4 cm above the umbilicus, at the superior left quadrant and 4cm below on the left of the prior trocar. The robot was docked. At twenty centimeters from the ileocecal valve, a 3 cm segment of ileum was dissected and suspended intrabdominal through percutaneous sutures. Then it was transected, detubularized and retubularized around a 10 Fr catheter using continuous suture with 4-0 Polydioxanone and second layer with interrupted suture 5-0 Poliglecaprone 25. This conduit was anastomosed to the anterior wall of the bladder with creation of an anti-reflux tunnel with 4-0 Polydioxanone and fixated to the skin at the level of the umbilicus with 5-0 Poliglecaprone 25. A 10 Fr Foley catheter was left in place in the conduit. RESULTS: Total operative time was 3h 56min (skin to skin). Patient tolerated the procedure well and her pain was well controlled immediately in the post-operative (PO) period. He started Malone flushing in PO day 2, and regular diet in PO day 5. She was discharged home on PO day 6 with the 10 Fr Foley camped catheter placed on the umbilicus. Three weeks later, the umbilicus catheter was removed, and patient initiated her CIC through the umbilicus stoma q3hr. At 3 months follow up, patient continues catheterizing through her stoma each 3 hours without leaking between cath. CONCLUSIONS: The Monti-Yang continent Ileovesicostomy is an effective well-validated method to allow self-catheterization in selected patients. Even that our patient had multiple past abdominal surgeries (robotic assisted AUS, Malone procedure and, VP shunt placement), this procedure was performed totally robotic intracorporeal with good outcome. Expansion of robotic surgery make minimal invasive surgery more accessible even for complex urologic procedure in the pediatric population. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e222-e223 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cinthia Galvez More articles by this author Diana M. Lopategui More articles by this author Laura Horodyski More articles by this author Miguel Castellan More articles by this author Expand All Advertisement Loading ...