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Laparoscopic augmentation enterocystoplasty and Mitrofanoff for neurogenic bladder

  • Abstract
    As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis. References: 1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305. 2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7. 3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5. 4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75. 5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7. 6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6. 7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40. 8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2. 9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9. 10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53. 11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7. 12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43. 13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9. 14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9. 15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4. 16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10. 17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34. 18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21. 19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.
  • 00'08" Patient installation
    The patient is placed in a lithotomy position. A 10mm port is placed in the midline and accommodates a 0-degree scope, as well as two 5mm working ports. One of the two working ports is placed on the mid-clavicular line on the right side, and the other one on the left side. A slight Trendelenburg position is used and a left tilt helps to facilitate small bowel displacement, hence allowing to perform an appendicovesical anastomosis.
  • 00'37" Appendix dissection
    The appendix is mobilized, making sure that the required length is available to reach the anterior abdominal wall. A 3/0 chromic absorbable suture is placed at the base of the appendix. The appendix is then separated from the caecum.
  • 01'19" Ileum selection and preparation
    The ileum is selected and fixed to the wall to have sufficient access to manipulate and fashion the augmentation. The mesentery is then dissected to divide the ileum. This will allow to obtain the adequate portion for augmentation. The entero-entero anastomosis is performed with monocryl 3/0 using separate stitches. The ileal graft that will help to shape bladder augmentation is passed underneath the mesentery, and detubulization may be started. The ileal portion to be augmented is then detubulized. The posterior plate of the enterocystoplasty is performed with monocryl 3/0. The assistant exposes the portion of the ileum to create the posterior plate. The posterior wall of the bladder is then incised partially to create the necessary space to anastomose the augmentation, and the anterior wall of the bladder is lowered.
  • 04'32" Creation of Mitrofanoff appendicovesicostomy
    A 1cm portion of the distal appendix is removed. A 12 French catheter is used to dilate the diameter of the appendix and guide the anastomosis. The appendix is fixed to the abdominal wall by means of 2/0 nylon suture next to the lateral trocar through a hole previously made. The bladder is now partially fixed to the abdominal wall by 2/0 nylon suture and filled with saline in order to provide adequate exposure. A submucosal incision will allow for the creation of an intramural tunnel. The appendicovesicostomy is then performed circumferentially using interrupted 4/0 polyglactin suture.
  • 06'09" Fashioning bladder augmentation
    Bladder incision is extended, and bilateral ureteral stents are placed. The anterior wall of the bladder is divided to allow for the identification of the ureteral meatus through which ureteral probes are placed bilaterally. Ureteral probes will then be extracted through the abdominal wall. The prepared ileum is then positioned, and a continuous 3/0 monocryl suture is made. Anastomosis of the anterior bladder is carried out to the anterior ileal defect using the same kind of stitch. Bladder augmentation is controlled by filling it up with saline. The proximal end of the appendix is brought through the 8mm feeding tube hole, using 2/0 Vicryl. In addition, a combined technique of intra- and extra-corporeal suture is used to fix the appendix to the abdominal wall. Two drains are placed, one Redon drain underneath the vesicostomy and a laparoscopic drain next to the vesical augmentation.
  • Related medias
    As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis. References: 1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305. 2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7. 3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5. 4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75. 5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7. 6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6. 7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40. 8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2. 9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9. 10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53. 11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7. 12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43. 13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9. 14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9. 15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4. 16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10. 17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34. 18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21. 19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.