Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100？mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively. 1. Introduction Originally described in 1955, ileovesicostomy is a surgical procedure performed as an alternative to conservative medical management for patients with neurogenic bladder dysfunction. In an ileovesicostomy procedure, a segment of ileum is anastomosed to the native bladder, creating a low pressure urinary storage and drainage system designed to help prevent renal damage that is associated with high intravesical pressures. Ileovesicostomy can lead to an overall reduction in morbidity by reducing urinary tract infections, preventing renal damage, and giving patients freedom from the burden of intermittent catheterization [1–5]. With the advent of minimally invasive surgery and its subsequent adaptation to ileovesicostomy, intraoperative blood loss, postoperative morbidity, length of hospital stay, and postoperative pain have been reduced [6]. In addition, intracorporeal anastomosis of the bowel after isolation of adequate ileal length has been hypothesized to further reduce the risk of incisional hernia, mesenteric thrombosis and ischemia, and postoperative ileus [7]. Two prior reports of completely intracorporeal robotic-assisted laparoscopic ileovesicostomy, including our own, have been presented as technique videos at urologic meetings (refs); however, this is the first case that includes long term patient follow-up [8, 9]. 2. Case Presentation A 55-year-old white man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction presented to Urology Clinic with urodynamic studies demonstrating high pressure neurogenic detrusor overactivity (180？cm？H2O). High pressures were documented despite an 18-month period of compliance with a regimen consisting of oral antimuscarinic therapy, fluid restriction, and intermittent self-catheterization. Relevant surgical history included ruptured appendix/peritonitis followed by appendectomy and bowel surgery and intrathecal baclofen pump placement in the left upper quadrant. He was referred for management