Pediatric Urology, Section of Urology, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? There is a single case reported in the literature describing this approach in Prune-Belly Syndrome. To our knowledge there are two case reports and two series in which laparoscopic appendicovesicostomy using the da Vinci robotic system was performed with good results. There are also several case reports of appendicovesicostomy creation using a pure laparoscopic approach. Additionally several case reports have described combined procedures involving pure laparoscopic and robotic assisted techniques, including appendicovesicostomy with concurrent augmentation, nephrectomy, orchiopexy, antegrade continence enema and cecostomy tube placement. Nguyen et al. have a similar experience in terms of number of patients (ten) who have undergone RALMA, but have not operated on patients with PBS. To our knowledge this is the largest series of patients undergoing RALMA in patients with Prune-Belly Syndrome.
To evaluate the feasibility and report our initial experience with Robotic- Assisted Laparoscopic Mitrofanoff Appendicovesicostomy (RALMA) in patients with prune belly syndrome. The Mitrofanoff appendicovesicostomy procedure uses the appendix to create an easily accessible continent, catheterizable channel into the urinary bladder. Historically, the procedure is performed by an open surgical approach in prune belly patients. We describe our initial experience herein.
Between October 2008 and February 2010 three patients with prune belly syndrome underwent RALMA. The appendicovesicostomy anastomosis was performed on the anterior bladder wall and the stoma was brought to the umbilical site or right lower quadrant. At least 4 cm of detrusor backing was ensured. The appendicovesicostomy stent was left in place for 4 weeks postoperatively before initiation of catheterization.
Mean age at surgery was 9.7 years (range 5-14 years). Blood loss volume was 20 mL in each case. Overall mean operative time was 352 min (range 319-402 min). There were no intraoperative complications and no open conversions. There was one postoperative complication in the form of wound infection. All patients are catheterizing their stomas and are continent at an average follow-up of 14.7 months (range 5-21 months).
In our initial experience, RALMA is a feasible option with encouraging early experience for creating a continent catheterizable channel into the urinary bladder in patients with prune belly syndrome.
Written by:
Wille MA, Jayram G, Gundeti MS. Are you the author?
Reference: BJU Int. 2011 Jul 28. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10317.x
PubMed Abstract
PMID: 21794067
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