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.
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.