101 / 492
09:39 - 09:42
S5-6
(PP)
INTRAOPERATIVE MRI-GUIDED NAVIGATION OF THE PELVIC FLOOR DURING
CLASSIC BLADDER EXSTROPHY AND CLOACAL EXSTROPHY CLOSURE
Heather DI CARLO
1
, Eric MASSANYI
2
, Bhavik SHAH
3
, Aylin TEKES
4
and John GEARHART
1
1) Johns Hopkins Children's Center, Pediatric Urology, Baltimore, USA - 2) Akron Children's Hospital, Pediatric Urology,
Akron, USA - 3) University of South Florida, Urology, Tampa, USA - 4) Johns Hopkins Children's Center, Pediatric
Radiology, Baltimore, USA
PURPOSE
Radical dissection of the urogenital fibers and the thickened smooth and striated muscle fibers connecting the posterior
urethra and bladder plate to the diastatic pubic rami is crucial for adequate placement of the posterior vesicourethral
unit deep within the pelvis during classic bladder exstrophy (CBE) and cloacal exstrophy (CE) closure, and ensuring
successful outcomes. Intraoperative MRI-guided navigation of the pelvic floor offers a novel technique for identification
of crucial anatomic landmarks during closure.
MATERIAL AND METHODS
IRB and FDA approval was obtained for use of Brainlab® (Munich, Germany) intraoperative MRI-guided navigation of
the pelvic floor during closure of CBE and CE at the authors’ institution. Pre-operative pelvic MRI was obtained one day
prior to CBE or CE closure in patients necessitating pelvic osteotomies. Intraoperative registration was performed after
pre-operative planning with a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of
surgery. Accuracy of identification of anatomy was assessed by three pediatric urologic surgeons and one pediatric
radiologist.
RESULTS
Twenty patients with CBE and two patients with CE closed at the authors’ institution have successfully utilized Brainlab®
technology to navigate and guide the dissection of the pelvic floor intraoperatively. All patients had 100% accuracy in
correlation of gross anatomic landmarks with MRI identified landmarks intraoperatively, and all have had successful
closure of CBE without any complication.
CONCLUSIONS
Brainlab® intraoperative MRI-guided pelvic floor navigation and dissection is an effective way to accurately identify
pelvic anatomy during CBE and CE closure. This technology offers a unique opportunity for surgical skill education in
this complex reconstructive operation. Future assessment of real-time changes in pelvic floor anatomy comparing pre-
closure to post-closure MRI will allow quantification of pelvic floor anatomy in CBE and CE patients and may allow for
intra-institutional telementoring in this most important first step of exstrophy reconstruction.