Tips and tricks for robot-assisted laparoscopic appendicovesicostomy in pediatric patients with neurogenic and non-neurogenic bladder dysfunction.

INTRODUCTION: Robotic appendicovesicostomy (R-APV) is a minimally invasive procedure that allows for bladder drainage via catheterization, where the appendix serves as a conduit between the bladder and an abdominal wall stoma. It is commonly performed in pediatric patients with neurogenic and other forms of bladder dysfunction. We aim to demonstrate our surgical technique and highlight key technical modifications that may optimize outcomes in this population. METHODS: The video describes our technique for R-APV in a 10-year-old female with a history of non-neurogenic bladder bowel dysfunction and bilateral hydroureteronephrosis. The attached video highlights key steps of our procedure: (a) appendiceal isolation using a hitch stitch; (b) suture ligation of the base of the appendix and surrounding appendiceal arteries; (c) bladder mobilization towards the umbilicus using a hitch stitch. RESULTS: From August 2014 to February 2024, 11 pediatric patients underwent R-APV at our institution, often in conjunction with other procedures. 5 patients (45%) underwent channel revision at a median of 3.8 years after initial surgery. CONCLUSION: Robotic appendicovesicostomy allows for safe and effective creation of catheterizable channels in pediatric patients with neurogenic and non-neurogenic bladders. The use of hitch stitches and suture ligation may increase channel length, reduce anastomotic tension, and contribute to durable functional outcomes. However, similar to open surgery, channel revisions are often needed in the pediatric population.