Continent urinary diversions are sometimes necessary for neurological bladder in patients unable to perform self-catheterization by the urethra.
The objective of this video was to present a technique of Mitrofanoff continent cystostomy by laparoscopic robot-assisted approach.

We present the case of 27 years old female. She present a C6 spinal cord injury since 2019. She has a neurological bladder with an overactive bladder treated by intradetrusor botulinum toxin injections and anticholinergics, and a detrusor-sphincter dyssynergia with  chronic urinary retention. 
She is unable to do urethral self-catheterizations and she refused a non continent urinary diversion by ileal conduit.
After discussion in a neurourology multidisciplinary team meeting, a continent Mitrofanoff cystostomy by the robotic approach is proposed.

We start by placing the trocars: one trocar above the umbilicus for the optic, one in the right pararectal line, one in the left pararectal line and one in the left iliac fossa for the robot arms and a 12 mm assist trocar in the right iliac fossa. The Da Vinci Xi robot is docked on the left side of the patient (side docking).  
The appendix is located. It appears to be of good size and caliber. It is disconnected from the caecum at its basis while preserving the meso appendix, then catheterized with a 12-F catheter.
The bladder is then completely removed from the abdominal wall. The bladder dome appears mobilizable up to the umbilicus. We do a longitudinal opening of the detrusor muscle at the top of the bladder until reaching the bladder mucosa. The bladder mucosa is opened and the distal part of the appendix is anastomosed to the mucosa by two running sutures of 5/0 PDS. 
An antirefluxing tunnel is made by closing the detrusor above the appendix with separate stitches of 3/0 Polysorb. It is about 4 cm long. 
The bladder is attached to the abdominal wall about 3 cm below the umbilicus and 3 cm on either side of the midline using a Reverdun needle. The appendix is externalized in the lower part of the umbilicus. It is hooked up to the fascia and then anastomosed to the skin. We finish by closing the trocar holes.

The operative time was 210 minutes with minimal blood loss. There was no postoperative complications. The patient was discharged on postoperative day 5. The cystostomy catheter was removed at 3 weeks and the patient was able to begin her self-catheterization by the conduit without difficulties.

The need for a urinary diversion by continent cystostomy remains a rare situation. The robot-assisted approach appears feasible. Studies are needed to determine if it could reduce perioperative morbidity compared to the open approach.

Continence 2S2 (2022) 100485
DOI: 10.1016/j.cont.2022.100485