Surgeons Perform World's First Pediatric Robotic Bladder Reconstruction

A 10-year-old Chicago girl born with an abnormally small bladder that made her incontinent has become the first patient to benefit from a new robotic-assisted bladder-reconstruction method developed by surgeons at the University of Chicago Medical Center. Although Gundeti had performed the operation to enlarge and relax a tiny spasmodic bladder many times, it had never been done robotically--an approach that has produced quicker recovery, less pain and minimal scars in other procedures. "This is a major, lengthy operation," he said, "essentially five smaller procedures done in sequence." Known as an augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy, the surgery normally begins with a big incision, about six inches long, from above the navel down to the pubic area, followed by placement of retractors to pull the stomach muscles out of the way. "The robotic approach enabled us to avoid that entire incision, which causes significant post-operative pain, presents an infection risk and leaves a big scar," Gundeti said. Instead, the robotic tools enter the abdomen through five small, dime-sized holes. In this operation, the surgeons use about 12 inches of intestine to reconstruct a larger bladder, "more than twice the original size," said Gundeti. "Plus, it can no longer contract with the same force." Then they converted the appendix into a "continent conduit," a drain for the new, expanded bladder, with one end implanted into the wall of the bladder and the other end leading outside the body through small outlet in the lower abdomen. A skin flap covers the fleshy appendix opening. "No one had ever done the full operation this way," Gundeti said. "It requires a lot of familiarity with both the open operation and considerable laparoscopic experience."

http://www.sciencedaily.com/releases/2008/11/081120090604.htm