V10-07: Step-By-Step Approach for Robotic Intracorporeal Continent Ileocecal Augmentation Cystoplasty
VideoIntroductions and Objectives
Although laparoscopic and robot-assisted ileocystoplasty and Mitrofanoff appendicovesicostomy techniques have previously been described, to our knowledge there have been no reports of intracorporeal continent ileocecal augmentation cystoplasty (Indiana augment) in the literature. Recently, we have described our experience with intracorporeal urinary diversions following robot-assisted radical cystectomy, including intracorporeal ileal conduit, ileal neobladder, and continent cutaneous pouch. Herein, we provide the first description of our technique of robot-assisted laparoscopic continent ileocecal augmentation cystoplasty, including the results of our initial experience in two patients.
We provide a step-by-step description of our intracorporeal approach to bowel mobilization and segmentation, ileocolonic anastomosis, tapering of the catheterization channel, reinforcement of ileocecal valve, preparation of the bladder, construction of the bladder augment, and stoma creation. We also include details of instruments and sutures required and describe optimization of port utilization and technique for robot positioning.
Robot-assisted laparoscopic continent ileocecal augmentation cystoplasty was successfully performed intracorporeally in two patients at our institution using the described technique. Mean operative time was 5 hours, without significant blood loss or intraoperative complications. Mean length of stay was 14 days. The first patient developed small bowel obstruction requiring laparoscopic lysis of adhesions, while the second patient had prolonged ileus due to neurogenic bowel. At 3 weeks post-operatively, cystogram was performed in both patients. The malecot catheter was capped, and the patients began catheterizing via the cutaneous stoma. The malecot catheter was subsequently removed.
We demonstrate that robot-assisted laparoscopic continent ileocecal augmentation cystoplasty (Indiana augment) is technically feasible and safe. Early functional results are promising. To our knowledge, this is the first description in the literature of intracorporeal continent ileocecal augmentation cystoplasty.