On November 14, Dr. Marie Auger-Hunault, pediatric surgeon, and Dr. Simon Bernardeau, urologist, performed an enterocystoplasty on a 10-year-old patient, entirely robot-assisted, a first for the pediatric department of the University Hospital of Poitiers. Explanation.
What is enterocystoplasty?
Enterocystoplasty is a surgical technique that involves using part of the digestive tract to enlarge or reconstruct the bladder. This technique is mainly practiced by urological surgeons, in the functional treatment of neurological bladders or in the context of cancer surgery. In the case that interests us here, the team removed approximately 10 cm of intestine in order to enlarge the bladder of a 10-year-old girl who had continence problems due to a very small bladder capacity. (70ml). “For comparison, a 10-year-old girl has an average bladder of 300 ml”, says Dr. Auger-Hunault. The advantage of taking a piece of intestine for bladder enlargement is that it will shape over time. The enlargement achieved during the operation is therefore not final and the bladder may continue to grow at the same time as the young girl.
The constraints of robot-assisted surgery in pediatrics
You should know that at the Poitiers University Hospital, the pediatrics department does not have a dedicated robotic operating range. Operating a child with the robot therefore requires that a surgeon with operating ranges give way to pediatric surgeons. This is what Dr. Simon Bernardeau, urologist, specialist in robot-assisted surgery, has been doing regularly for regarding two years, in order to offer operations relating to his specialty. Doctor Marie Auger-Hunault is, for the moment, the only pediatric surgeon to have operated jointly with Doctor Bernardeau. She did part of her internship in Tours, where she trained in the use of the robot since the University Hospitals of Tours and Limoges are the first centers to have used a surgical robot in paediatrics. Regularly, Dr. Bernardeau and Dr. Auger-Hunault therefore perform robot-assisted surgeries. “It is a real benefit for young patients since we have been able to observe that those who have been operated on with the robot remain under observation one day less than the others”, says Dr. Auger-Hunault. However, to be able to perform these operations in robotic surgery, it is necessary that the child be “big enough” to be able to set up the robot, although some centers tend to reduce this limit. Indeed, in Poitiers, the limit adopted to be able to use a robot on a child is to have, at least, 15 cm between the xyphoid (lower end of the sternum) and the pubis. In the operation of enterocystoplasty performed recently, it is the first time that the four arms of the robot were used on a child, in Poitiers.
Enterocystoplasty by robotic assistance: rare expertise
Enterocystoplasty is a rare operation which is currently mainly performed for pediatrics, in open surgery or laparoscopy. The robot is very advantageous because unlike open surgery, there is less risk of occlusions on flanges (infection following operation). Moreover, there is also a cosmetic benefit with the reduction in the size of the scars. In robot-assisted surgery, there is also a real gain since it allows much better intraoperative vision, and therefore easier sutures to perform, with a 360° rotation of the arms. The operating time was 4h30. Other centers perform this surgery, the duration of which can sometimes be up to 9 or 9.30 hours of surgery. Here, it’s an operation that was really done with four hands between Dr. Auger-Hunault and Dr. Bernardeau. “If I had to perform the operation alone, it would have taken twice the time” says Dr. Auger-hunault. Doctor Simon Bernardeau already had the expertise of performing enterocystoplasty on adults. “This is what makes the strength of a hospital on a human scale, the great cooperation between departments, taking advantage of each other’s know-how to improve patient care!” “. You should know that this operation requires a large number of sutures. There is therefore a significant post-operative monitoring time in order to monitor in particular the risks of leaks at the level of the digestive or bladder anastomoses. The young girl remained under surveillance for 10 days and to this day has had very good post-operative results. For her, it’s a real life change since, even if she’s a young girl who was used to self-examination, she no longer wears nappies and gradually finds serenity in her everyday life. days.
On the strength of this successful experience, Dr. Marie Auger-Hunault wishes to continue to develop the activity of robot-assisted pediatric surgery. In particular, she hopes to develop visceral surgery operations with the help of Doctor David Soussi Berjonval and Professor Jean-Pierre Faure.
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