Clinic Study Of Laparoscopic Radical Cystectomy With Orthotopic Detenial Sigmoid Neobladder

Objective To present our exerience of intracoiporeal laparoscopic radical cystectomy (LRC) and assess the feasibility of laparoscopic radical cystectomy with orthotopic detenial sigmoid neobladder to treat the patients with muscle-invasive bladder cacinoma.Methods There were 12 male and 4 female 44-68 years old with organ confined,muscle invasive transitional cell carcinoma of the bladder who underwent surgery. The procedure include radical cystectomy with prostate or uterus underwent with intracoreal laparoscopic technique exclusively.Removal of the mobilized specimens and urinary diversion operation were managed via a 5-7cm small suprabic abdominal incision(laparostomy). The urinary diversion procedure includes:Construction of the detenial sigmoid pouch, bilateral stented antiflux implantation of the ureter in the pouch and orthotopic anastomose of neobladder and urethra.Results 16 cases were performed successfully.Operating tine was 5.75 to 9.5 hours (median 7.5h,LRC time 3.5 hour) and bloodlose was 200 to 800 ml.(median 400 ml ).blood transfusion 4u.Oral intake was started on hospital day 4~5,ureteral stents were removed with in 3 week and the pouch catheter was removed in 4 week.Histopathological examination of the specimens revealed urothelial carcinoma of bladder.The lymph nodes and resection margins were tumor-free. No intraoperative complications were observed. No local recurrence was observed during a follow up of 12 months (l-22months).Day time continence was 100%. Incontinence occurred in 3 case unusualy at night time.Conclusion With more experiment and improvement of the surgical technique, the laparoscopic radical cystectomy with extracorporeal continent urinary diversion (detenial sigmoid pouch),with small incision and rapid recovery, may become an alternative surgical method for patients with localized muscle invasive bladder cancer.