Laparoscopic evaluation of two different anti-reflux techniques of uretero-intestinal anastomosis: metabolic impact

Split-nipple [n=10] and the submucosal tunnel [n=10] antireflux uretero-intestinal anastomotic techniques were performed employing 12 female pigs with average weight ranging from 35 to 40 kg. Preoperative intestinal preparation, both chemical and mechanical, was achieved 48 hours prior to surgery. Renal panel was also performed for all animals pre- and postoperatively. A 5-port trans-peritoneal technique was employed. The procedure comprised bilateral dissection of the ureters, hemicystectomy, isolation of a 20 cm ileal segment, ureter-intestinal anastomosis and ileo-cystoplasty. Animals were followed up for a period ranging from two weeks to three months. Bilateral antireflux uretero-ileal anastomoses were completed in all 10 animals with average total operative time of 4.5 hours and mean blood loss of 40 ml. All technical maneuvers could be performed completely intracorporealy using laparoscopic techniques. Mean pre- and postoperative serum creatinine was 1.1 and 1.2 mg%, respectively. All animals were non refluxing, however, two of the split-nipple uretero-ileal anastomosis had ureteral strictures. There were no significant metabolic effects of using intestinal segments in this procedure

Laparoscopic intracorporeally-constructed Ileal conduit after porcine cystoprostatectomy

Introduction and Objectives: ileal conduit urinary diversion following cystoprostatectomy has not been reported by the laparoscopic intrracorporeal technique to date. Herein, we present our technique of laparoscopic ileal conduit following cystoprostatectomy in the porcine model performed in a completely intracorporeal manner. After developing the technique in 5 acute animals, laparoscopic cystoprostatectomy with intracoporeally performed ileal conduit urinary diversion was performed in 10 male survival pigs. A 5-port transperiloneal technique was used. All steps of the technique as applied during open surgery were duplicated intracorporeally, Specifically, cystectomy, isolation of an ileal conduit, restoration of bowel continuity, and mucosa to mucosa, stented bilateral ileoureteral anastomosis were performed with exclusively intracorporeal laparoscopic techniques. Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and operating time 'averaged 290 minutes. An end ileal stoma was formed at the right lower quadrant port site. At euthanasia, renal function was normal in all surviving animals. No ileoureteral anastomotic strictures were noted on pre-euthanasia loopgrams or on post-mortem examination of the anastomotic sites. Laparoscopic ileal conduit urinary diversion .following cystoprostatectomy can be performed completely intracorporeally in the porcine model. Clinical application of this technique is imminent