V544 SIMULTANEOUS ROBOTIC ASSISTED LAPAROSCOPIC CONTINENT CATHETERIZABLE CHANNELS: THE SPLIT APPENDIX TECHNIQUE

Abstract

You have accessJournal of UrologyPediatrics1 Apr 2012V544 SIMULTANEOUS ROBOTIC ASSISTED LAPAROSCOPIC CONTINENT CATHETERIZABLE CHANNELS: THE SPLIT APPENDIX TECHNIQUE Dennis Liu, Marcelo Orvieto, and Mohan Gundeti Dennis LiuDennis Liu Chicago, IL More articles by this author , Marcelo OrvietoMarcelo Orvieto Chicago, IL More articles by this author , and Mohan GundetiMohan Gundeti Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.618AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Creation of continent catheterizable channels with and without augmentation is often necessary for children with neurogenic bladders to obtain fecal [Malone Antegrade Continent Enema (MACE)] and urinary continence (Mitrofanoff Appendicovesicostomy). Traditionally, these channels have been created with open surgery, often requiring creation of a Monti channel and/or a cecal flap. We present our experience with simultaneous robotic assisted laparoscopic Mitrofanoff Appendicovesicostomy (RALMA) and robotic assisted laparoscopic MACE (RALMACE) using the split appendix technique, enabling creation of both channels using solely the appendix. METHODS The patient is positioned in a modified 25° trendelenburg position with legs positioned in Allen stirrups. A 12 mm camera port is placed 12 cm superior to the pubic symphysis and 2 8 mm robotic ports are placed on either side of the camera port. An assistant port is placed in the left upper quadrant. The appendix is isolated and split into a 5 cm distal segment for use as the Mitrofanoff and the proximal 2 cm for use as the MACE. The appendicovesicostomy is created by formation of an anti-refluxing tunnel in the anterior wall of the bladder. When concomitant augmentation cystoplasty is performed, the appendicovesicostomy is tunneled intravesically in the posterior wall of the bladder. The appendicovesicostomy is brought out to the skin at the umbilicus. The MACE is brought out in the right lower quadrant without imbrication. Stomas are matured using the V-flap technique. RESULTS We have performed the RAL split appendix technique in three patients. Two of the patients also required augmentation cystoplasty while one did not. Fecal and urinary continence has been obtained in all patients and no complications have been encountered. CONCLUSIONS Simultaneous RAL creation of the Mitrofanoff appendicovesicostomy and MACE using the split appendix is an effective minimally invasive surgical technique that avoids the need for a Monti channel. Longer follow-up and comparison with open surgery are needed to confirm the utility of this approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e223 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dennis Liu Chicago, IL More articles by this author Marcelo Orvieto Chicago, IL More articles by this author Mohan Gundeti Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...