Background: Laparoscopic bladder augmentation has been limited due to the extensive suturing required. The use of robotic-assisted laparoscopy surgery (RALS) may circumvent this limitation, allowing laparoscopic suturing to be done more efficiently. The purpose of our study is to evaluate the feasibility of performing bladder augmentation using RALS in an animal model.
Methods: Ten minipigs underwent bladder augmentation using RALS. Augmentation was performed using 20 cm of ileum. In five animals the bowel anastomosis were performed intraperitoneally using an endo-GIA stapler. In the others, the bowel ends were externalized through one of the ports and a free-hand bowel anastomosis was performed. The surgical time was recorded for each part of the procedure. The bowel-bowel and bowel-bladder anastomosis were evaluated for patency and leakage.
Results: The mean total procedure time was 6:44 hours (range =5:50-8:05hs) with a rapid learning curve. The mean bowel-bowel anastomosis time was equivalent in the two groups. However, leakage at the bowel-bowel anastomosis occurred in one animal using the stapler technique. Leakage at the bowel-bladder anastomosis was seen in two animals. However, this was minimal and could be managed with Foley tube drainage.
Conclusions: Bladder augmentation using RALS can be safely and efficiently performed. There is a rapid learning curve. External bowel-bowel anastomosis using a free hand technique may avoid risk of leakage.