Mediathek
Total robot-assisted laparoscopic ileal pouch construction following radical cystectomy: video and case report
Abstract
Total robot-assisted laparoscopic ileal pouch construction following radical cystectomy: video and case report
C. Malkmus1, M. Moschini1, L. Mordasini1, K. Decaestecker2, A. Mattei1
1Luzerner Kantonsspital, Urologie, Luzern, Schweiz, 2Universität Gent, Gent, Belgien
Background and objective: Minimally invasive robot-assisted techniques have shown to be feasible even in complex urinary diversions. This video illustrates the case of a 28-year-old tetraplegic male who underwent robot-assisted cystectomy with a neo-bladder reconstruction and continent Mitrofanoff stoma due to neurogenic bladder dysfunction. The video focuses step-by-step on the creation of the continent pouch and the appendicovesicostomy after the cystectomy.
Material and methods: The appendix and ileum (50cm) are transected with staplers. Side-to-side restoration of bowl continuity with staplers. The appendix is embedded and fixed between two u-shaped ileal limbs and splinted with a catheter. It is subsequently covered after antimesenterial transection of the ileal limbs sparing 15cm of a tubular afferent segment. Reconstruction of the dorsal pouch. Catheterization of the continence mechanism before ventral closure of the pouch. Dorsal reconstruction of the ureteroileal anastomosis with a Wallace plate. Splinting of the ureters with SJ catheters and insertion of a cystostomy. Ureteroileal anastomosis and the pouch are finished and the continence mechanism is fixed to the umbilicus.
Results: Total operative time was 9 hours, blood loss 250ml. Discharge of the patient after 12 days. Adverse events were obstructive pyelonephritis and pulmonary embolism. After 6 months catheterization was performed 7x/d, pouch volume was about 500ml. After 12 months renal function was not impaired.
Conclusions: Total robot-assisted laparoscopic Mitrofanoff appendicovesicostomy is feasible in expert hands. The procedure is technically demanding and should be restricted to experienced centers. Standardization of the intervention might help to improve safety and reproducibility
