Robotic Ileovesicostomy: Initial Experience

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Background:
Ileovesicostomy has been shown to be an effective treatment for adults with neurogenic bladder who are incapable or otherwise unwilling to perform chronic intermittent catheterization. Our goal was to assess the feasibility, safety, and efficacy of a minimally invasive robotic ileovesicostomy.
Methods:
One surgeon performed 5 robotic ileovesicostomies. Inclusion criteria included patients with a neurogenic bladder unable to perform clean intermittent catheterization, and who were poor candidates for chronic indwelling bladder catheterization. Exclusion criteria were previous intraperitoneal surgery or pathology. Patient demographics, urodynamic, operative, and post operative data were recorded. All surgeries were performed transperitoneal with a DaVinci S robot and minimally invasive technique was used to duplicate the open surgical procedure. Robotic operative steps included 1) Removing peritoneum from posterior bladder wall; 2) Creation of a full thickness U shaped posterior bladder wall flap; 3) Intracorporeal harvesting a 15 cm piece of terminal ileum using an endo GIA stapler; 4) Enterovesical anastomosis between harvested bowel and bladder flap. A 2x2 cm counter incision was then made over the marked stoma site and an extracorporeal side-side small bowel anastomosis was completed to restore bowel continuity, followed by ileovesicostomy stoma maturation.
Results:
Patient demographic and urodynamic data are provided in the table. 6 cases were attempted with one immediate conversion due to unanticipated intraperitoneal adhesions from diverticulitis. Median estimated blood loss was 100 ml, (75-250 ml), and no patients required blood transfusion. Median operative time was 450 minutes, (375-465 min) and no intraoperative complications occurred. During the post operative recovery, bowel function resumed after a mean of 5.6 days, (4-7 days) and mean length of hospital stay was 7.8 days, (6-10 days). Over a mean 8.2 month follow up, all patients had a functioning ileovesicostomy and median postoperative post void residual was 50 ml, (0-100 ml) at last visit. Post operative complications included prolonged intubation for 48 hours (1 patient), pneumonia (1), stomal stenosis (1), and urethal incontinence (1).
Conclusions:
Robotic ileovesicostomy can be performed safely with minimal morbidity while providing excellent urinary drainage in patients with a neurogenic bladder who are unable to perform intermittent catheterization.

Total Cases	5
Mean Age (years)	55 (range 42-68)
Median BMI (kg/m2)	29.6 (range 21.6-37.4)
Median Preop Bladder Compliance (cc/cmH20)	20.7 (range 2-48)
Median Operative Time (min)	450 (range 390-465)
Median EBL (ml)	100 (range 75-250)
Transfusions (%)	0
Median Postop Postvoid Residual (ml)	50 (range 0-100)
Average Length of Stay (days)	7.8 (range 6-10)
Average Return to Bowel Function (days)	5.6 (range 4-7)
Complications Stoma stenosis Ileus Respiratory Failure Urinary Tract Infection Pneumonia Urethral leakage Bowel Complications	1 1 1 1 1 1 0

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