Analysis of anastomotic line perfusion with fluorescent molecular imaging after augmentation ileocystoplasty in open and robot-assisted laparoscopic surgery

Abstract

Objective: An important complication of the augmentation ileocystoplasty is bladder perforation. Some authors have proposed that perforations result from ischemic necrosis in the bladder-bowel anastomotic sites. The aim of this study was to evaluate the tissue perfusion in the anastomotic suture line in augmentation ileocystoplasty performed with various techiques. Material and Methods: Four swines were used. The animals were divided into two groups, in pairs. In group 1, augmentation ileocystoplasty with U patch single-layer anstomosis (SLA) and U patch two-layer anastomosis (TLA) were performed by open surgery (OS). In group 2, the same procedures were performed with robot-assisted laparoscopic surgery (RALS). The perfusion of the bladder-ileum anastomotic line was evaluated by photodynamic eye. Results: The median width of the ischemic zone in SLA was 5 mm (range 2-14 mm) in OS, and 3 mm (range 2-14 mm) in RALS. The median width of the ischemic zone in TLA was 13 mm (range 10-19 mm) in OS, and 8 mm (range 4-12 mm) in RALS. Conclusion: In augmentation ileocystoplasty, intraoperative evaluation of the ischemic zone in the anastomotic line by photodynamic eye is an effective and feasible method. Single or two-layer anastomosis, perfomed either by OS or RALS seems to be not causing significant change in the ischemic zones. However, longterm results of similar studies should be determined to show the role of ischemia in the etiology of bladder perforations after augmentation ileocystoplasty.