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S29: VIDEO SESSION 2
Moderators: Gregory Dean (USA), Rita Gobet (Switzerland)
ESPU Meeting on Saturday 17, October 2015, 16:49 - 17:30
16:49 - 16:54
S29-1
(VP)
★
ROBOT-ASSISTED LAPAROSCOPIC BLADDER AUGMENTATION IN THE
PEDIATRIC PATIENT
Patricia CHO, Ashley WIETSMA, Carlos ESTRADA and Richard YU
Boston Children's Hospital, Harvard Medical School, Urology, Boston, USA
INTRODUCTION
Bladder augmentation is a common surgical intervention for neuropathic bladder dysfunction, and has conventionally
been an open procedure. Technological advancements have allowed minimally invasive approaches to be utilized. The
feasibility and safety of robot-assisted laparoscopic bladder augmentation in pediatrics has been reported. We present a
robotic ileocystoplasty to demonstrate the feasibility of an entirely intracorporeal approach in a pediatric patient.
METHODS
The patient was a 6 year old (18.5 kg) boy with a neurogenic bladder secondary to lumbar myelomengiocele. He did not
have a ventriculoperitoneal shunt and had no previous intraabdominal surgery. Despite maximum anticholinergic
therapy and clean intermittent catheterization (CIC) 5 times per day, urodynamic studies revealed a small capacity and
poorly compliant bladder with a maximum detrusor storage pressure >40 cmH
2
O. He was incontinent between
catheterizations. A robotic augmentation cystoplasty was performed.
RESULTS
A three robotic arm setup was used with a fourth assistance laparoscopic port. Total surgical time was 496 minutes.
There were no intraoperative complications and the patient was discharged on post-operative day 8. At one-month
postoperatively, a cystogram revealed no urine leak, and the suprapubic tube was removed. The patient resumed CIC
every 3 hours during the day and once overnight until postoperative urodynamic studies confirmed safe dynamics, after
which the CIC interval could be lengthened.
CONCLUSIONS
Robotic bladder augmentation is safe and feasible in a select pediatric population. The entire procedure including
preparation of the bowel segment can be completed intracorporeally even in smaller children. With further experience,
operative times will approach those of open augmentation cystoplasty.