Minimally Invasive Laparoscopic Neobladder

摘要

No AccessJournal of UrologyCLINICAL UROLOGY: UROLOGISTS AT WORK1 Sep 2002Minimally Invasive Laparoscopic Neobladder F. Gaboardi, A. Simonato, S. Galli, A. Lissiani, A. Gregori, and A. Bozzola F. GaboardiF. Gaboardi , A. SimonatoA. Simonato , S. GalliS. Galli , A. LissianiA. Lissiani , A. GregoriA. Gregori , and A. BozzolaA. Bozzola View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64579-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: To our knowledge orthotopic reconstruction after laparoscopic radical cystectomy has not been described in the human. After anatomical and surgical studies on cadavers we developed an original technique and performed the first laparoscopic radical cystectomy with pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction in a patient. Materials and Methods: Our technique has 3 steps, namely laparoscopic pelvic clearance, external reconstruction and laparoscopic reconstruction. After cystoprostatectomy and lymphadenectomy were completed via laparoscopy we removed the surgical specimens through a 5 cm. supraumbilical incision. Through the same incision an ileal loop was extracted from the abdominal cavity, isolated, detubularized and partially reconfigured. Intestinal continuity was restored extracorporeally. All intestinal loops were inserted back into the abdomen and pneumoperitoneum was started again. The ureteroileal (nipple valve) and urethroileal anastomoses were formed via laparoscopy and the neobladder was then completed with an intracorporeal running suture. Results: Operative time was 450 minutes and blood loss was 350 ml. Postoperatively pain was minimal. The patient was ambulatory, regained bowel activity on postoperative day 2 and began food intake 2 days later. He was discharged home on postoperative day 7 with an indwelling catheter, which was removed after 7 days. Histopathological examination showed organ confined bladder cancer without margin invasion. Conclusions: To our knowledge we report the first case of laparoscopic radical cystectomy with ileal orthotopic reconstruction. This original technique combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery. References 1 : Laparoscopic radical prostatectomy: the Montsouris experience. J Urol2000; 163: 1643. Link, Google Scholar 2 : Future developments perspectives in laparoscopy. Eur Urol2001; 40: 84. Crossref, Medline, Google Scholar 3 : Editorial: new laparoscopic approaches. J Urol2001; 165: 1967. Link, Google Scholar 4 : Laparoscopically assisted transvaginal radical cystectomy. Eur Urol1995; 27: 80. Crossref, Medline, Google Scholar 5 : Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology2000; 56: 26. Crossref, Medline, Google Scholar 6 : Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases. J Urol2001; 165: 1863. Link, Google Scholar 7 : Laparoscopic assisted cystectomy lymphadenectomy for bladder cancer: initial experience. World J Surg1999; 23: 608. Crossref, Medline, Google Scholar 8 : Laparoscopic orthotopic ileal neobladder. J Endourol2001; 15: 131. Crossref, Medline, Google Scholar 9 : The everting suture: a new technical aid for ureteral nipple construction. J Urol1996; 155: 1372. Link, Google Scholar 10 : Lower urinary tract reconstruction following cystectomy: experience results in 126 patients using the Kock ileal reservoir with bilateral ureteroileal urethrostomy. J Urol1991; 146: 756. Link, Google Scholar 11 : The ileal neobladder: complications functional results in 363 patients after 11 years of followup. J Urol1999; 161: 422. Link, Google Scholar 12 : Three years' experience with an ileal low pressure bladder substitute. Br J Urol1989; 63: 43. Crossref, Medline, Google Scholar 13 :