Robotic-assisted ileovesicostomy: initial results.

OBJECTIVES

To assess the safety and efficacy of robotic-assisted ileovesicostomy in treating patients with a neurogenic bladder that is unsuitable for clean intermittent self-catheterization.

METHODS

Robotic-assisted ileovesicostomy was performed using a 5-port approach for patients with a neurogenic bladder unable to tolerate clean intermittent or chronic bladder catheterization. Intraperitoneal operative steps included the creation of a full thickness U-shaped posterior bladder wall flap, intracorporeal harvesting of 15 cm of terminal ileum for use as a urinary conduit, and intracorporeal enterovesical anastomosis. Then, a counter incision was made over the marked stoma site on the abdominal wall, and bowel continuity was restored through an extracorporeal side-side anastomosis by the stomal incision. Ileovesicostomy stoma maturation was then completed.

RESULTS

Eight robotic ileovesicostomies were performed. The median patient age was 53 years, body mass index was 29.0 kg/m(2), and preoperative bladder compliance was 5.7 mL/cm/H(2)O. The median blood loss was 100 mL. The median operative time was 330 minutes (range 240-420). No intraoperative complications occurred. Four patients had postoperative complications, including urethral incontinence (2) and ileus (2). No wound complications occurred. Bowel function returned after a median of 4.8 days after surgery, and median hospital stay was 7.7 days. Over a median 14-month follow-up, all patients had a functioning ileovesicostomy, and median postoperative residual bladder volume was 10 mL.

CONCLUSIONS

This study is the first to describe the robotic ileovesicostomy procedure. Robotic ileovesicostomy appears to be safe and effective, with low morbidity.