V05-07: TOTALLY INTRACORPOREAL LAPAROSCOPIC RADICAL CYSTECTOMY WITH MODIFIED ILEAL PADUA NEOBLADDER RECOSTRUCTION IN MALE. SURGICAL APPROACH EVOLUTION AND OUTCOMES
Aim of the present study is to report our 3 years experience and results of totally intracorporeal laparoscopic radical cystectomy (LRC) with orthotopic urinary diversion in males. In this video we reported the description of our surgical technique.
A prospective study was performed on males suffering from Muscle Invasive Bladder Cancer (MIBC) or high risk Non Muscle Invasive Bladder Cancer (NMIBC) undergoing laparoscopic radical cystectomy that was planned from January 2014 to August 2017. The LRC procedure is started by establishing a pneumoperitoneum and the insertion of two 5 mm, two 10 mm trocars and one Hasson 12 mm trocar. The procedure is started by dissection of peritoneum in the Douglas Pouch. Then Radical cystoprostatectomy is made, hemostasis and electrodissection are performed using the 5 mm ligasure. A bilateral standard lymphadenectomy was performed. Urinary diversion is configured as a modified ileal padua neobladder reconstruction selecting 40 centimeters of the ileum. 25 centimeters are used for the left arm and 15 centimeters are used for the right arm. The posterior plate of the neobladder is made using a 45mm long automatic stapler. The remaining neobladder configuration is made with absorbable 3-0 running suture.A 14F drain is left in the abdominal cavity after surgery.
24 males underwent laparoscopic radical cystectomy during this 44 months study period. All patients were submitted to (LRC) with orthotopic Padua urinary diversion. The mean operative time was 384 ± 27 minutes, the mean blood loss was 219.69± 95.59 milliliters, the mean length of hospital stay was 7.62 ± 2 days and the mean morphine requirement was 2.54 ± 0.7 days. The overall complication rate was 54.2% (13/24). However, the majority of the patients had minor complications with minimally-invasive re-interventions needed.
Laparoscopic radical cystectomy is a safe and effective choice to treat patients affected by bladder cancer that can provide an alternative to open radical cystectomy. A real learning curve is not needed if the surgical team works in a high volume hospital and has a previous large experience with urologic general laparoscopy and laparoscopic radical prostatectomy. On the other hand, laparoscopic urinary reconstructions must be considered challenging procedures were the surgical team needs a consolidate experience to select the correct diversion and a large experience in using minimal invasive tools, devices and sutures to optimize the surgical steps of the procedure.