Robot-assisted Laparoscopic W-shaped Ileocystoplasty in Children.

Abstract

Robot-assisted bladder augmentation in children is rarely utilized across Europe. Performing this procedure robotically with an ileal loop "W" configuration is innovative. We analyzed the preliminary results of our experience in robotic-assisted laparoscopic W-shaped ileocystoplasty (RALAWI) in children. A prospective bicentric study included all patients who had RALAWI (2020-2024). The procedures were performed using the DaVinci Xi robot. The statistical analysis was descriptive (median [range]) and comparative. Thirteen patients were included (age 9.5 [5-16] yr, weight 31 [19-99] kg), and followed up for 15.5 (12-50) mo. Etiologies included the following: neuropathic bladder (nine cases), bladder exstrophy (two cases), rhabdomyosarcoma (one case), and bilateral ectopic ureters (one case). All procedures were performed intra-abdominally without conversion. The median operative time and length of stay were 670 (450-930) min and 12 (6-30) d, respectively. The associated procedures were extraserosal appendicovesicostomy (APV; eight cases), bladder neck reconstruction (six cases), bladder neck closure (one case), and bilateral ureteral reimplantation (two cases). Six patients had multiple abdominal surgeries previously. Four patients had complications at <30 d: urinary anastomotic leakage (N = 2, IIIB according to Clavien-Dindo), abscess (N = 1, IIIA), and ventriculoperitoneal shunt dysfunction (N = 1, IIIB). Five patients had nine complications at >30 d: stoma leakage (three cases, IIIB), bladder stone (one case, IIIB), difficult catheterization (two cases, IIIB), and ileocystoplasty perforation (one case, IIIB, and one case, IVA). None had APV stenosis. Postoperative bladder capacity was significantly higher (170 vs 350 ml; p < 0.01). All patients achieved continence. To our knowledge, this is the first report of robot-assisted ileocystoplasty in children with a W-shape reconfiguration. It is feasible even after multiple surgeries, offering potential benefits for patients with fragile abdominal wall. The technique requires further refinements to reduce operative time and early postoperative complications.