Elsevier

Urology

Volume 152, June 2021, Page 200
Urology

“Show Me How” Video
Technique and Outcomes of Hand-Assist Laparoscopic Continent Cutaneous Ileocecocystoplasty

https://doi.org/10.1016/j.urology.2021.01.019Get rights and content

ABSTRACT

Background

Continent cutaneous ileocecocystoplasty (CCIC) involves reconfiguring the ileocecal segment for use as a bladder augment and continent catheterizable channel. CCIC requires release of the hepatic flexure of the colon, which necessitates a longer midline laparotomy than would be required for a standard bladder augmentation. This is associated with high rates of ventral and parastomal hernias.

Objectives

To describe the technique of hand-assist laparoscopic CCIC and to compare outcomes to open CCIC.

Materials and Methods

We found pure laparoscopic colon mobilization difficult due to significant colonic distension in patients with neurogenic bladder and bowel. We modified our approach to hand-assisted laparoscopic mobilization for better retraction of the bowel. A 12-mm camera port is placed through the umbilicus, which later serves as the stoma site, and a 5-mm assist port is placed a handbreadth cephalad to the 12-mm port. A Pfannenstiel incision is made for use as the hand port. After colonic mobilization is completed the remainder of the procedure is performed in an open fashion through the Pfannenstiel incision. The primary outcome was 90-day Clavien grade 2 or greater complications. Secondary outcomes included revision rates, wound infection, urinary continence, operative time, and length of stay. Data was analyzed using Mann-Whitney U test and Fisher's exact test.

Results

Thirty-two laparoscopic and 21 open procedures were reviewed. Those who underwent open procedures were more likely to have undergone prior catheterizable channel or bladder augmentation (7 vs 1, P < .01). There were fewer 90-day complications in the laparoscopic group (18.8% vs 47.6%, P = .03). There was no difference in operative time, hospital length of stay, wound infections, need for subsequent channel revision, or long-term continence between groups.

Conclusion

Hand-assist laparoscopic CCIC offers a minimally invasive alternative to open CCIC with fewer short-term complications and comparable long-term outcomes.

Section snippets

CONFLICTS OF INTEREST

Thomas Stout: Nothing to disclose; Joshua Roth: Nothing to disclose; Ronak Gor: Nothing to disclose; Joseph Pariser: Nothing to disclose; Sean Elliott: Nothing to disclose.

The following is the video related to this articleVideo 1.

Technique and Outcomes of Hand-Assist Laparoscopic Continent Cutaneous Ileocecocystoplasty.

The following is the video related to this articleVideo 1.

Technique and Outcomes of Hand-Assist Laparoscopic Continent Cutaneous Ileocecocystoplasty.

References (0)

Cited by (2)

Declarations of Interest: None.

View full text