Robot-Assisted Laparoscopic Intracorporeal Hand-Sewn Bowel Anastomosis During Pediatric Bladder Reconstructive Surgery* Mohan S. Gundeti, M.Ch., FRCS (Urol), FEAPU, Aimee L. Wiltz, M.D., Gregory P. Zagaja, M.D., and Arieh L. Shalhav, M.D. Abstract Bowel anastomosis performed during robot-assisted laparoscopic surgery in both adult and pediatric popula- tions has typically been performed using endoscopic staplers or with exteriorization of the bowel. In the pediatric population, no articles have been published that explore the possibility of a completely intracorporeal hand-sewn anastomosis during robot-assisted laparoscopic surgery. We report our series of six children who were undergoing robot-assisted laparoscopic intracorporeal hand-sewn bowel anastomosis during bladder re- constructive surgery for neurogenic bladder. The postoperative course was uncomplicated with regard to the bowel anastomosis, demonstrating the feasibility of the technique in experienced hands. Introduction T echniques in laparoscopic bowel surgery have been described in adult literature for the management of obe- sity, colorectal disease, and bladder cancer. In the pediatric literature, demonstration of these techniques has most often been in the context of augmentation cystoplasty for neuro- genic bladder. Most commonly, resection of the bowel is performed intracorporeally, followed by the use of endo- scopic staplers to perform the anastomosis 1 vs a small incision to allow extracorporeal anastomosis. 2 There have been stud- ies, however, that demonstrate the feasibility of laparoscopic intracorporeal hand-sewn bowel anastomosis in patients undergoing Roux-en-Y gastric bypass 3,4 in patients as young as 13 years. Even fewer studies have been published that describe the techniques of bowel anastomosis in robot-assisted laparos- copy, because this is a relatively new technology that is gaining increasingly widespread acceptance. In most of these studies, bowel anastomosis is also performed extracorpore- ally 5 or intracorporeally with endoscopic staplers. 6,7 An ani- mal study by Passerotti and associates 8 demonstrated the feasibility of a hand-sewn bowel anastomosis performed ex- tracorporeally in the setting of a robot-assisted augmentation cystoplasty. Only one study has been published using a completely intracorporeal hand-sewn bowel anastomosis in adult pa- tients who were undergoing robot-assisted laparoscopic duodenal switch, 9 and no studies in the pediatric literature are published to our knowledge. We describe our technique for performing a completely intracorporeal hand-sewn bowel anastomosis in children who were undergoing robot-assisted laparoscopic intestinal aug- mentation cystoplasty after our first successful case report in the pediatric literature. 10 Patients and Methods Between February 2008 and November 2008, six patients (5 girls and 1 boy ranging in age from 8 to 14 years) with a diagnosis of neurogenic bladder secondary to spina bifida underwent robot-assisted laparoscopic bladder reconstructive surgery with an ileocystoplasty and appendicovesicostomy. Institutional Review Board approval was obtained for the collection of data in a prospective database. The database in- cluded preoperative patient characteristics, including height, weight, age, ambulatory status, bowel habits, management of constipation, and presence of ventriculoperitoneal (VP) shunt. All patients had undergone a preoperative assessment con- sisting of a history, physical examination, voiding cystoure- throgram, renal bladder ultrasonography, nuclear renal scan, and urodynamic studies. Patients ranged in height from 93 to 160.5 cm and in weight from 34.0 to 61.4 kg. VP shunt was present in two patients. These patients were also wheelchair bound, while the re- maining four were ambulatory. Four patients had constipation Section of Urology, Department of Surgery, Comer Children’s Hospital, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois. *A video demonstrating this technique is available online at www.liebertpub.com. JOURNAL OF ENDOUROLOGY Volume 24, Number 8, August 2010 ª Mary Ann Liebert, Inc. Pp. 1325–1328 DOI: 10.1089 = end.2009.0463 1325