V10-03: Robotic Appendicovesicostomy Revision in a Pediatric Neobladder Patient
Robot-assisted surgical techniques are being applied to increasingly complex procedures. Early case series suggest that there is a role for robotic approaches in appendicovesicostomy creation and bladder augmentation. However, reoperative surgeries for reconstruction are preferentially performed open, owing to the potential for intra-abdominal adhesions. In this video, we present a robot-assisted laparoscopic revision of an appendicovesicostomy channel on a patient with a neobladder.
Our patient is a six year-old female that presented with hematuria and was diagnosed with a metastatic malignant rhabdoid tumor. After initial radiographic response to chemotherapy, the patient underwent a radical cystectomy with ileal conduit urinary diversion. Post-operatively, she received further chemotherapy in addition to radiation treatment. Upon follow-up the patient was noted to be free of disease and underwent composite neobladder reconstruction using large bowel and ileum with creation of an appendicovesicostomy channel. Post-operatively the patient suffered from stomal incontinence refractory to anticholinergic therapy, as well as endoscopic injections of Botox and Deflux. Successful robotic revision of the appendicovesicostomy channel was achieved by creating a new tunnel and wrapping the channel with the neobladder.
Operative time was 4 hours and 57 minutes. Estimated blood loss was 10 mL. Our patient was discharged on post-operative day one with a 12 French catheter draining the neobladder through the channel. Two weeks post-operatively, a pouchogram was performed demonstrating no leak and the catheter was subsequently removed. At two months follow-up, the patient is completely dry per stoma on an every four hour catheterization regimen.
To our knowledge, this video is the first report of a robotic appendicovesicostomy revision on a patient with a neobladder. With careful patient selection and appropriate counseling, we believe that certain patients may benefit from robotic reoperative reconstructive surgery.