title: A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy.
abstract: BACKGROUND
  Robotic techniques are increasingly being used for reconstructive procedures in the pediatric population.
  
  
  OBJECTIVE
  The present study reported the functional and perioperative outcomes of a multi-institutional cohort of pediatric patients who underwent robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy (RALMA).
  
  
  METHODS
  Pediatric patients who underwent RALMA at five different centers were included. Positioning is shown (Summary Figure). Demographics were gathered, and intraoperative parameters included concomitant procedures, detrusor tunnel length, estimated blood loss (EBL) and operative time. Perioperative outcomes included length of hospital stay (LOS), morphine use and 30-day complications. Outcomes were reported in terms of stomal continence and surgical revisions.
  
  
  RESULTS
  Eighty-eight patients with a mean age of 10.4 ± 4.0 years were included in the analysis. Median follow-up was 29.5 months (IQR 11.8-45.0). Bladder augmentation was performed concomitantly in 15 (17%) patients, and bladder neck procedures in 34 (39%). Mean detrusor tunnel length was 3.9 ± 1.0 cm, EBL was 54 ± 70 ml, and operative time was 424 ± 120 min. Postoperatively, mean LOS was 5.2 ± 2.8 days. Patients who underwent concomitant augmentation had higher EBL and operative times (both P < 0.05). At 90 days, complications occurred in 26 patients (29.5%) with six Clavien grade ≥3 (6.8%). During follow-up, 11 (12.5%) patients required appendicovesicostomy revision. Regarding functional outcomes, 75 (85.2%) patients were initially continent. After additional procedures, 81 (92.0%) patients were continent at last follow-up.
  
  
  CONCLUSIONS
  Compared to previous open series, initial stomal continence rates with RALMA were acceptable, with a minority of patients requiring subsequent procedures to manage complications and achieve continence.
  
  
  CONCLUSIONS
  RALMA is safe and effective in a pediatric population with regard to perioperative complications and stomal continence.
authors.affiliation: Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Mohan S
authors.initials: MS
authors.lastname: Gundeti
authors.affiliation: Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Petravick
authors.affiliation: Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA. Electronic address: pariserj@gmail.com.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Pearce
authors.affiliation: Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Blake B
authors.initials: BB
authors.lastname: Anderson
authors.affiliation: Texas Children's Hospital, Houston, TX, USA.
authors.forename: Gwen M
authors.initials: GM
authors.lastname: Grimsby
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Ardavan
authors.initials: A
authors.lastname: Akhavan
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Pankaj P
authors.initials: PP
authors.lastname: Dangle
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Aseem R
authors.initials: AR
authors.lastname: Shukla
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Cannon
authors.affiliation: Texas Children's Hospital, Houston, TX, USA.
authors.forename: Patricio C
authors.initials: PC
authors.lastname: Gargollo
mesh_terms: D001062:Appendectomy / Q000379:methods*; D002648:Child; D003559:Cystostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D020127:Recovery of Function; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods
keywords: Appendix; Clean intermittent catheterization; Mitrofanoff; Neurogenic; Robotics