Laparoscopic Radical Cystectomy with Orthotopic Neobladder

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Abstract
We report our technique of laparoscopic radical cystectomy in nine patients. Diversion was achieved by a modified Camey II orthotopic neobladder (the Y bladder) performed by a minilaparotomy in three cases and laparoscopically in the last six cases. There were eight men with muscle-invasive transitional-cell carcinoma and one woman with verrucous squamous-cell carcinoma of the bladder. The age range was 41 to 65 years. The control of the posterior and lateral bladder pedicles was achieved by vascular Endo-GIA in the first three cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the last six cases. The operative specimen was extracted through a 3- to 5-cm muscle-splitting incision in the right iliac fossa. The detubularized pouch was prepared extracorporeally through the same incision. The urethral and ureteral anastomoses were performed using laparoscopic intracorporeal suturing in the last six cases. The operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood loss was 150 to 500 mL. Oral feeding was resumed on the 3rd postoperative day. The stents were usually removed on the 8th postoperative day. A pouchogram was obtained on the 10th postoperative day, and the urethral catheter was removed. The lymph nodes as well as the surgical margins were tumor free. Laparoscopic radical cystectomy and orthotopic neobladder creation is feasible, although difficult and technically demanding. The use of the Harmonic Shears in the cystectomy reduces the operative cost significantly. With growing experience, laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique.