Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective,Pediatric Surgery International

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Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective
Pediatric Surgery International ( IF 1.5 ) Pub Date : 2024-02-24 , DOI: 10.1007/s00383-024-05641-z
Claire A Ostertag-Hill ₁ , Prathima Nandivada ₁ , Hatim Thaker ₂ , Carlos R Estrada ₂ , Belinda H Dickie ₁

Affiliation

Purpose

A robotic-assisted laparoscopic approach to appendicostomy offers the benefits of a minimally invasive approach to patients who would typically necessitate an open procedure, those with a larger body habitus, and those requiring combined complex colorectal and urologic reconstructive procedures. We present our experience performing robotic-assisted appendicostomies with a focus on patient selection, perioperative factors, and functional outcomes.

Methods

A retrospective review of patients who underwent a robotic-assisted appendicostomy/neoappendicostomy at our institution was performed.

Results

Twelve patients underwent robotic-assisted appendicostomy (n = 8) and neoappendicostomy (n = 4) at a range of 8.8–25.8 years. Five patients had a weight percentile > 50% for their age. Seven patients underwent combined procedures. Median operative time for appendicostomy/neoappendicostomy only was 185.0 min. Complications included surgical site infection (n = 3), stricture requiring minor operative revision (n = 2), conversion to an open procedure due to inadequate appendiceal length (prior to developing our technique for robotic neoappendicostomies; n = 1), and granuloma (n = 1). At a median follow-up of 10.8 months (range 1.7–74.3 months), 91.7% of patients were consistently clean with antegrade enemas.

Discussion

Robotic-assisted laparoscopic appendicostomy and neoappendicostomy with cecal flap is a safe and effective operative approach. A robotic approach can potentially overcome the technical difficulties encountered in obese patients and can aid in patients requiring both a Malone and a Mitrofanoff in a single, combined minimally invasive procedure.

中文翻译：

机器人辅助腹腔镜 Malone 阑尾造口术：6 年展望

目的

机器人辅助腹腔镜阑尾切开术为通常需要开放手术的患者、体型较大的患者以及需要联合复杂的结直肠和泌尿系统重建手术的患者提供了微创方法的好处。我们介绍我们进行机器人辅助阑尾切开术的经验，重点关注患者选择、围手术期因素和功能结果。

方法

对在我们机构接受机器人辅助阑尾造口术/新阑尾造口术的患者进行了回顾性审查。

结果

12 名患者接受了机器人辅助阑尾造口术 ( n = 8) 和新阑尾造口术 ( n = 4)，年龄范围为 8.8-25.8 岁。 5 名患者的体重百分位数 > 其年龄的 50%。七名患者接受了联合手术。仅阑尾造口术/新阑尾造口术的中位手术时间为 185.0 分钟。并发症包括手术部位感染（ n = 3）、需要进行小手术修复的狭窄（ n = 2）、由于阑尾长度不足而转为开放手术（在开发我们的机器人新阑尾切除术技术之前； n = 1）和肉芽肿（ n = 1）。中位随访时间为 10.8 个月（范围 1.7-74.3 个月），91.7% 的患者通过顺行灌肠始终保持清洁。