In utero treatment for bladder outlet obstruction using robot assisted laparoscopic techniques.
OBJECTIVE
Bladder outlet obstruction can have devastating consequences. Given the poor outcome, intervention in utero has been advocated in an attempt to salvage pulmonary and renal function. We evaluated whether laparoscopic decompression of the obstructed bladder could be performed efficiently by adapting current robot assisted laparoscopic techniques to access the fetus in utero.


METHODS
At 95 days of gestation 20 fetal sheep underwent ligation of the urethra and urachus. Two to 5 days later robot assisted laparoscopic vesicostomy was performed. Ultrasound of the kidneys and bladder was performed before each procedure. At 135 days of gestation the urinary tract was evaluated to assess the adequacy of bladder decompression and a patent vesicostomy.


RESULTS
After 48 hours of undergoing ligation all fetuses had bilateral moderate hydronephrosis and a markedly distended bladder. In the first 10 fetuses vesicostomy could not be completed laparoscopically due to limited visualization. Additional modifications in trocar placement and gas infusion allowed vesicostomy to be completed laparoscopically in the last 8 fetuses in 2.5 to 4 hours. Urinary tract decompression and a patent vesicostomy were observed in all of these fetuses postoperatively.


CONCLUSIONS
We developed specific modifications in current robot assisted laparoscopic techniques and instrumentation to allow the treatment of bladder outlet obstruction in utero. This procedure may be performed efficiently and it may provide advantages over conventional surgery for fetal intervention.
Passerotti
Carlo C
CC
Department of Urology (Robotic Research and Training Center), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
Barnewolt
Carol
C
Xuewu
Jiang
J
Passerotti
Ana Maria A M S
AM
Ward
Valerie
V
Dunning
Patricia
P
Retik
Alan B
AB
Nguyen
Hiep T
HT
D000818:Animals; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012371:Robotics; D012756:Sheep; D001748:Urinary Bladder Neck Obstruction / Q000196:embryology / Q000601:surgery*