Robotic Mitrofanoff with Right Lower Quadrant Stoma
Jayson Kemble, DO, Kevin Hanna, MD, Elizabeth Olive, MD, Patricio Gargollo, MD, Candace Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Clean intermittent catheterization (CIC) has revolutionized neurogenic bladder management, and is typically done per urethra. Some patients require an alternative CIC route through a catheterizable stoma, often at the base of the umbilicus. However, anatomic variations may preclude a tension-free umbilical stoma placement.
Methods: Here, we demonstrate our approach to a robotic Mitrofanoff with right lower quadrant stoma placement in a pediatric patient.
Results: After mobilizing the right colon, the appendix is identified, tied off, and mobilized off the cecum while maintaining the mesoappendix. The bladder is taken down with electrocautery and hitched to the anterior abdominal wall with 2-0 PDS while being stretched toward the right lower quadrant. An 8-French feeding tube with the tip cut off was passed into the appendix to prepare for the anastomosis, and the distal appendix is spatulated. After filling the bladder, a 5cm long trough is created in the muscularis propria, providing adequate length for coaptation of the appendix for future continence. The bladder mucosa is sharply entered and the appendiceal anastomosis is performed with 5-0 Vicryl sutures circumferentially. The feeding tube is passed into the bladder and secured at the proximal appendix. The muscularis propria is then closed over the top of the appendix with 3-0 Vicryl and 3-0 Quill suture. The appendix is brought through the abdominal wall, and creation of the stoma is then carried out in the standard fashion. There were no intraoperative complications. Total operative time was 150 minutes, and estimated blood loss was 5 ml. The patient tolerated the procedure well and discharged on post op day one, with his pain well controlled with only oral Tylenol.
Conclusions: This case shows that a robotic approach to a right lower quadrant Mitrofanoff channel can safely and efficiently be utilized in patients with anatomic variations that preclude Mitrofanoff stoma placement through the umbilicus, or in patients with a preference for stoma placement in locations other than the umbilicus.
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