Abstract
Laparoscopic bladder augmentation has been limited because of the extensive suturing required. The use of robot-assisted laparoscopic (RAL) procedures may circumvent this limitation and allow more efficient suturing. The purpose of the study is to define the techniques and the potential pitfalls in performing RAL bladder augmentation in an animal model. Ten swine underwent RAL bladder augmentation using 20 cm of ileum. In five animals, the bowel anastomosis was performed intracorporeally. In the others, the bowel ends were externalized through one of the ports, and a free-hand bowel anastomosis was performed. The operative time was recorded. The anastomoses were evaluated for patency and leakage. The mean procedure time was 6 hours 44 minutes (range 5 hours 50 min-8 hours 5 min) with a rapid learning curve. We identified minor technical modifications that were helpful, such as placement of "hitch stitches," irrigation of the isolated bowel loop extracorporeally, and leaving the bladder wall attachment intact to maintain bladder suspension. Leakage at the bowel-bowel anastomosis occurred in one animal with use of a stapling technique. Because this could be a potentially fatal complication, we altered our technique to perform the...Continue Reading
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