TY - JOUR
T1 - Robot-assisted laparoscopic ileal bladder augmentation
T2 - Defining techniques and potential pitfalls
AU - Passerotti, Carlo C.
AU - Nguyen, Hiep T.
AU - Lais, Alberto
AU - Dunning, Patricia
AU - Harrell, Bruce
AU - Estrada, Carlos
AU - Lee, Richard
AU - Retik, Alan B.
AU - Peters, Craig A
PY - 2008/2/1
Y1 - 2008/2/1
N2 - Purpose: Laparoscopic bladder augmentation has been limited because of the extensive suturing required. The use of robot-assisted laparoscopic (RAL) procedures may circumvent this limitation and allow more efficient suturing. The purpose of the study is to define the techniques and the potential pitfalls in performing RAL bladder augmentation in an animal model. Materials and Methods: Ten swine underwent RAL bladder augmentation using 20 cm of ileum. In five animals, the bowel anastomosis was performed intracorporeally. In the others, the bowel ends were externalized through one of the ports, and a free-hand bowel anastomosis was performed. The operative time was recorded. The anastomoses were evaluated for patency and leakage. Results: The mean procedure time was 6 hours 44 minutes (range 5 hours 50 min-8 hours 5 min) with a rapid learning curve. We identified minor technical modifications that were helpful, such as placement of "hitch stitches", irrigation of the isolated bowel loop extracorporeally, and leaving the bladder wall attachment intact to maintain bladder suspension. Leakage at the bowel-bowel anastomosis occurred in one animal with use of a stapling technique. Because this could be a potentially fatal complication, we altered our technique to perform the bowel-bowel anastomosis outside the peritoneal cavity. Subsequently, there was no further incidences of bowel leakage, and all anastomoses were patent. The mean bowel-bowel anastomosis time was equivalent to using the two techniques. Leakage at the bowel-bladder anastomosis was seen in two animals, both occurring early in the series. Conclusion: RAL bladder augmentation can be safely and efficiently performed. There is a rapid learning curve. We identified minor technical modifications in techniques to help reduce operative time and potential complications. We recommend performing the bowel-bowel anastomosis outside the peritoneum to avoid the risk of leakage. Leakage at the bowel-bladder anastomosis may occur but can be managed with simple catheter drainage.
AB - Purpose: Laparoscopic bladder augmentation has been limited because of the extensive suturing required. The use of robot-assisted laparoscopic (RAL) procedures may circumvent this limitation and allow more efficient suturing. The purpose of the study is to define the techniques and the potential pitfalls in performing RAL bladder augmentation in an animal model. Materials and Methods: Ten swine underwent RAL bladder augmentation using 20 cm of ileum. In five animals, the bowel anastomosis was performed intracorporeally. In the others, the bowel ends were externalized through one of the ports, and a free-hand bowel anastomosis was performed. The operative time was recorded. The anastomoses were evaluated for patency and leakage. Results: The mean procedure time was 6 hours 44 minutes (range 5 hours 50 min-8 hours 5 min) with a rapid learning curve. We identified minor technical modifications that were helpful, such as placement of "hitch stitches", irrigation of the isolated bowel loop extracorporeally, and leaving the bladder wall attachment intact to maintain bladder suspension. Leakage at the bowel-bowel anastomosis occurred in one animal with use of a stapling technique. Because this could be a potentially fatal complication, we altered our technique to perform the bowel-bowel anastomosis outside the peritoneal cavity. Subsequently, there was no further incidences of bowel leakage, and all anastomoses were patent. The mean bowel-bowel anastomosis time was equivalent to using the two techniques. Leakage at the bowel-bladder anastomosis was seen in two animals, both occurring early in the series. Conclusion: RAL bladder augmentation can be safely and efficiently performed. There is a rapid learning curve. We identified minor technical modifications in techniques to help reduce operative time and potential complications. We recommend performing the bowel-bowel anastomosis outside the peritoneum to avoid the risk of leakage. Leakage at the bowel-bladder anastomosis may occur but can be managed with simple catheter drainage.
UR - http://www.scopus.com/inward/record.url?scp=39749111948&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=39749111948&partnerID=8YFLogxK
U2 - 10.1089/end.2007.0238
DO - 10.1089/end.2007.0238
M3 - Article
C2 - 18211210
AN - SCOPUS:39749111948
SN - 0892-7790
VL - 22
SP - 355
EP - 360
JO - Journal of Endourology
JF - Journal of Endourology
IS - 2
ER -