Robotic Assisted Laparoscopic Mitrofanoff Appendicovesicostomy: Preliminary Experience in a Pediatric Population

Purpose: Continent urinary diversion has a central role in treating various urinary tract conditions and traditionally has been performed as an open procedure. We report on 10 patients who underwent a robotic assisted laparoscopic Mitrofanoff procedure using the da Vinci® surgical system. Materials and Methods: Patients had bladder dysfunction of various etiologies, including posterior urethral valves and neurogenic bladder. Preoperatively all patients unsuccessfully attempted clean intermittent catheterization via the urethra. Results: Mean operative time was 323 minutes (range 181 to 507). One case was converted to open surgery secondary to an inadequate appendix discovered intraoperatively. Mean estimated blood loss was 48.4 cc (range 5 to 200). Median hospitalization was 5 days. Median followup was 14.2 months. Urinary leakage developed postoperatively in 1 patient, requiring an open revision. Minor incontinence developed in 2 cases, of which 1 was corrected with dextranomer/hyaluronic acid injection and 1 resolved without intervention. Conclusions: The robotic assisted laparoscopic Mitrofanoff procedure is feasible to perform, is associated with satisfactory outcomes and minimal complications, and has the benefits of a minimally invasive approach.